Wednesday, July 20, 2016

Healthy Heart

My primary care physician called last night with the results of Monday's treadmill stress test with nuclear imaging.  As I remember what he said:

  • Nuclear scans showed no evidence of significant obstruction in any vessel of the heart.  This is a very good prognostic factor.
  • Whereas 9 minutes on the treadmill is good for a man of 75, I went 14 minutes, which is much more difficult and an excellent prognostic factor.  (The treadmill exercise increases significantly in both speed and incline every 3 minutes). 
  • The angina-like symptom could have been a clot that cleared by itself.  I doubt that, because it has lasted for months - I have notes back to April 20 at least, and even a note as far back as May, 2015. 
  • It could also be a small-vessel ischemia, not visible on the scans.  This could cause the feeling of angina (but perhaps would not be especially dangerous?).  Again, why does it go all the way back to April or last year? 
  • No reason to do an angiogram.  I agreed, especially since I know that an angiogram poses its own risks. 
  • No reason for medication.  Nitroglycerin, in particular, is not really a treatment for heart disease, but is prescribed to alleviate pain.  To me, the pain may be a helpful signal to back off. 
  • When running, it's OK to push until I feel the symptom, but then cut back until it goes away. 
  • He asked if I was taking any blood thinners, and seemed satisfied when I told him I was taking an 82 mg aspirin twice per day.  
  • He said that he would not be offended if I spoke next to a cardiologist.  I declined, but suggested I might like to get a second opinion on reading the scans.  He said that he and I could sit down and look through the images together, they are not difficult to read, and then I suggested that I might see if I can get a copy on DVD.  Perhaps I'll set up an appointment with him if I have questions after viewing the scans myself.
Though this is wonderful news, I understand that I might still have heart disease, despite the dandy "prognostic indicators."  However, I now believe that the most likely cause of the angina-like symptom is exercise-induced reflux.  Heartburn.  Indeed on one fairly recent run, a few minutes after feeling the symptom, some of my stomach contents did come up into my mouth.  No nausea, just reflux.

I think that dexamethasone (DEX) and prednisone make the reflux more likely, as does a recent meal, of course.  Looking back through my blogs, I find that every complaint about chest pain occurred while I was taking DEX, often (though not always) on the very day after I took it.  Although I haven't felt the symptom for two weeks now, I believe that it will appear again when I push harder, and I will take careful notes.  Can't wait to get out there and push a little harder.

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