Chris DeWald: Stroke/heart stress test

Hello, readers. This is another adventure in my world that allows me to share information to you. I am going to be utilizing information from this website and tell you about “my time” and how fortunate we have such a great staff at Augusta Health: www.nvcardiology.com/nuclear_imaging.htm.

Now, how did I end up doing this test? I sure did not get an award for it. My general physician, Dr. Margaret Siman, felt it was necessary as I had sharp pains in my chest that would extend towards my arm. Since I had a previous myocardial infarction as well as a stroke, this seemed to be a safety net for me. Safety net indeed, I had just fallen the previous weekend and fractured my T-12 spinal bone. I missed my computer chair upon sitting. Sound familiar, anyone?

Let’s move along now, As coronary artery disease (CAD) progresses, the heart muscle may not receive enough blood supply when under stress. This often results in chest pain (angina pectoris) or shortness of breath. On the other hand, there may be no outward physical signs of significant disease. If CAD is limiting blood flow to part of your heart, the nuclear stress test may be useful in detecting the presence and significance of CAD.

A nuclear stress test is a diagnostic nuclear imaging study that uses radioactive tracers, called technetium and thallium, to produce images of the heart muscle. When combined with the stress component, either through exercise or use of an intravenous pharmacological agent, the nuclear stress images can help determine if the heart muscle is getting sufficient blood supply. After the radioactive tracers are injected through an IV, they travel in the bloodstream through the coronary arteries until they are picked up by the heart muscle. The areas of the heart that have an adequate blood supply pick up the tracer right away and more completely while areas that do not have adequate blood supply pick up the tracer very slowly or not at all. The radioactive isotopes give off a small amount of radiation that is detected with a nuclear scanning camera. If an area receives less blood than the rest of the heart (because of a blocked or narrowed artery), it will pick up a lower level of radioactivity and will show up as a lighter area, called a “defect.” This is how we can tell whether or not there might be a blocked artery in the heart.

At Augusta Health, I went to the cardiology department and had the most pleasant receptionist. I wish I had taken her name, but she was extremely busy. I think she runs the show. I then was met a nuclear medicine technologist by the name of Jeffrey Byrd. This was my first chain of what I perceived as a scary procedure. He was very assuring and knowledgeable of the procedure and explained everything and anything I wanted to know. This is how I want to be treated as a patient. Jeffrey inserted an IV after painstakingly trying to find a useable vein. Why try? The previous day I had gone to the VA Outpatient for my yearly blood withdrawal. Do I need to tell you how many times I was stuck? OK, you guys can surmise the “point”…

That’s where the first injection of the radionuclides took place. It started out with the feeling of cold rushing into my arm. It then got warm but was gone in about 30 seconds. I had to sit for 30 minutes for the jungle juice just inserted in me to be into all my heart vessels. So I sat watching Dr. Oz with some laser hair removal system. Oh my, where is that remote?

Roberta Garrett, a medical medicine technologist, then removed my tortured TV vision self and brought me to the scanner. She was very informative and went over the procedure in detail. The scanner look similar to a CT scanner but it has openings that when it is close to your head, you have enough clearance in the instrument that no fears should arise if you have fear of close spaces as in an MRI. In an MRI,

I have to be highly sedated. I never was before my stroke, mind you.

The first part was simple. Then my IV was removed, a beautiful cosmetic bandage was applied and I was off until 7:30 the next day.

The next day I arrive and met with another nuclear medicine technologist by the name of Hunter Kline. Again, I was met by another very knowledgeable and thorough tech. I was led to the same “injection” room where another IV was secured. At least they had news on and the death of Liz Taylor was on the television so I had something to watch, but not long. I was then tossed into the hands of a pleasant tech by the name of Birdie. The name was so pleasant I felt she should be known as such. It seemed everyone else knew her. I knew my chest hair would not survive as she was going to hook me up to the heart sensors. She informed me of the procedure and what was to be done. First, the medicine to be injected into me was discussed.

What is Lexiscan?

Lexiscan, a substance engineered based on a naturally occurring substance in your body, when injected acts as a vasodilator. It increases the blood vessel circumference of the coronary arteries (arteries that feed the heart) in order to increase blood flow to the heart. We have selected Lexiscan to replace the previously used Adenosine because of the fewer associated side effects and its ease of use. Any side effects you may experience will be generally predictable, short-lived, and easily tolerated. Side effects can include: chest pressure, dizziness, shortness of breath, flushing, headache, lightheadedness, nausea, or numbness. Lexiscan should not be used in patients who have a hypersensitivity to this drug and in patients who have known severe bronchospastic or bronchoconstrictive lung disease (e.g., asthma or COPD and are using regular inhalers or wheezing is heard on examination of your lungs prior to the procedure). Each patient will be evaluated on the day of the procedure prior to the start of the stress test.

She was very thorough on this and especially the side effects. It seemed they really stressed this in the stress test (sic). Of course I had one of the side effects, why not? Mine was the flush feeling and a headache. My doctor monitoring the test was Dr. Gary Murray of Blue Ridge Cardiology. What a fantastic medical physician he was. He told me in 15 seconds the feelings would be gone. He was spot on. He had a nice reassuring smile like Norman Rockwell would paint.

I was then released for one hour to eat as I was told the eating made the next test easier to see. It was the same scanner I initially went through. I was told they compare the heart at rest taken the previous day to the one stressed out. I think the IV stressed me out more. After the scan, I was sent on my way. Would I go to this facility on a heart issue again, you betcha. But leave me alone hospital for now.

Thanks, readers.

Column by Chris DeWald


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