... reassured by the fact that a normal exercise EKG treadmill stress test has prognostic value-meaning that if you do well and there are no abnormalities, we are generally reassured that your heart-related risk is low. ...

I have a couple questions about the EKG stress tests: 1) It seems like they are not very "stressful", for folks who've been training. Does this reduce the value of the test? My last EKG treadmill stress test got up to their highest level and I remember thinking "Ok, now we can start running at a reasonable pace." The cardiologist came in, watched for a minute, and stopped the test. When I asked him why, he said there was no need to continue and that I probably could have gone on for 3 more minutes. I didn't have the heart (pun?) to tell him that I could have gone on for at least 45 minutes at that pace. So is it possible that the test would have given more useful data if it had been programmed to get to higher levels of exertion? I know my VO2 test got me up to a much higher level of effort than the EKG stress test (definitely above my Anaerobic Threshold, which isn't that far from my MHR.) 2) Is it common for runners (or other athletes) to have EKG results which in some cases could be a problem, but are "normal for them" ? I ask this because my personal physician always tells her assistants who give me an ordinary EKG with the annual physical, "That's normal for him." I asked the cardiologist at my last EKG treadmill stress test about a few things and he said "That's normal for you." I read a paper once titled something like "ECG Findings in Active Patients", and it sure seemed revealing. 3) ok, a third minor question: have you ever heard of a term like "Juvenile ????? Syndrome", which as far as I can tell is just another name for "Advance Repolarization" ? When a physician did a pre-surgery physical over 30 years ago, he said I had this "Juvenile... Syndrome" (I can't remember the exact term.) When I asked if that was bad, he said "Oh, no... I wish more of my patients had it..." and went on to explain that it was kind of like increasing the spark advance on your car's distributor to get more power. A final comment - people should be glad that physicians these days are more knowledgeable about what they might see in the hearts of trained athletes. There was a story many years ago about a top German runner (10K ?, ready for the World Championships?) being pulled from his team by a doctor who said immediate hospitalization for severe heart disease was necessary. As it turned out, the runner just had a highly trained heart and the physician wasn't familiar with that kind of patient. Gino

1) It seems like they are not very "stressful", for folks who've been training. Does this reduce the value of the test? 2) Is it common for runners (or other athletes) to have EKG results which in some cases could be a problem, but are "normal for them" ? 3) ok, a third minor question: have you ever heard of a term like "Juvenile ????? Syndrome", which as far as I can tell is just another name for "Advance Repolarization" ?

Gino- First, you should discuss these specific questions with your doctor. I do not practice medicine on the internet... 1) However, stress tests are useful in that we look at what happens with graded exercise-every increasing work on the heart. You see, the heart depends on an increased heart rate for it's own blood and oxygen supply. So when you exercise harder and harder, there can be clues to underlying heart disease by several things which are recorded with the ETT. These include: EKG changes, BP changes, symptoms or rhythm problems. People who can walk for 9, 12 or 15 minutes respectively are at low, very low and very,very low risk (respectively). 2) Many runners and other aerobically trained athlete's have slightly abnormal EKG's. I take care of several athlete's who are at a very high level and they all have abnormal EKG's that are 'normal' for them. 3). They may have been referring to a 'juvenille T wave' abnormality-which just means there is a persistent EKG change which is slow to go away in adulthood. Kids have this normally on EKG's very often. Now, all that being said, I've recently taken care of several very well trained athlete's who had symptoms of chest pressure/discomfort at a very high level of exertion. They had to go pretty far into the stress test before they got their usual symptoms...Subsequent cath showed CAD and successful PTCA was the treatment for both of them. So remember to respect symptoms that are out of the ordinary...

Dale--edit away--and thank you. We will send you a draft before publication. As you can see, this is a topic of a lot of interest. I will certainly be in touch with you--the Steamboat Springs paper wants to do an article, and I agreed, on the condition that it is focused on: 1) the EMTs who saved D. and 2) it is educational--and I copied and pasted your RA post. DH had a slightly elevated temp, so they gave him some red blood cells. He still got in 4 walks today, is eating solid food, all the tubes were out by this evening's walk. Cardiologist says Monday for discharge, Surgeon says Tuesday--we'll see who wins! grins, A

Dale, thank you so much for putting all this together! Having too much spare time has never been one of your problems, from what I've seen. I agree with what PDR mentioned recently... a lot of times we aren't taken seriously, so it's especially valuable to have access to as much accurate information as possible! I also have a few questions; I've haven't read all of your links yet so I apologize if these are answered in one of them & I missed it. I can't remember the name, but I think there's a test that will show if you've had an MI. If that's true, how for how long after the 'event' can you still test for it in that way? Would a stress/echo show if there's been any damage, even if it was minor? I had a very good CRP score, (<0.2) but take a probably ridiculous amount of assorted anti-inflammatories. would that in any way negate the value of the test? sort of like if your bp is good but you're on meds? what do you think about heart scans? what do you think about testing for lp(a)? does everybody really have a trivial pericardial effusion? like others, i have issues here, & will read again (& keep) this information. my pcp referred me to a cardiologist last year & although i liked him, i definitely felt like my questions/ concerns were being laughed off. but i still have symptoms that are 'out of the ordinary', & don't know how to approach it other than through learning as much as possible. so thank you thank you. i am in your debt. but="" take="" a="" probably="" ridiculous="" amount="" of="" assorted="" anti-inflammatories.="" would="" that="" in="" any="" way="" negate="" the="" value="" of="" the="" test?="" sort="" of="" like="" if="" your="" bp="" is="" good="" but="" you're="" on="" meds?="" what="" do="" you="" think="" about="" heart="" scans?="" what="" do="" you="" think="" about="" testing="" for="" lp(a)?="" does="" everybody="" really="" have="" a="" trivial="" pericardial="" effusion?="" like="" others,="" i="" have="" issues="" here,="" &="" will="" read="" again="" (&="" keep)="" this="" information.="" my="" pcp="" referred="" me="" to="" a="" cardiologist="" last="" year="" &="" although="" i="" liked="" him,="" i="" definitely="" felt="" like="" my="" questions/="" concerns="" were="" being="" laughed="" off.="" but="" i="" still="" have="" symptoms="" that="" are="" 'out="" of="" the="" ordinary',="" &="" don't="" know="" how="" to="" approach="" it="" other="" than="" through="" learning="" as="" much="" as="" possible.="" so="" thank="" you="" thank="" you.="" i="" am="" in="" your="" debt.=""></0.2) but take a probably ridiculous amount of assorted anti-inflammatories. would that in any way negate the value of the test? sort of like if your bp is good but you're on meds? what do you think about heart scans? what do you think about testing for lp(a)? does everybody really have a trivial pericardial effusion? like others, i have issues here, & will read again (& keep) this information. my pcp referred me to a cardiologist last year & although i liked him, i definitely felt like my questions/ concerns were being laughed off. but i still have symptoms that are 'out of the ordinary', & don't know how to approach it other than through learning as much as possible. so thank you thank you. i am in your debt. >

It is important to have a trusting relationship and if you weren't taken as seriously as you want, you might consider a second, third or fourth opinion...Good luck.

AMEN! I've been blessed with having lots of different docs 'cause I moved a round a bit. I can't believe how much a difference it makes being on the same wavelength (not necessarily of the same mind) with my "experts" as I like to think of them. It makes going to a doctor's appointment, even when I'm feeling lousy, a pleasurable event.

Btw, one more question. Re: "Do strides year round--Incorporate some 'form' work and 'neuromuscular training' by running some strides once or twice per week all year. This follows the rules of muscle memory and training specificity. Even during base training, some quicker turnover is important to keep the muscles stimulated and entrained. Strides, pickup or short reps accomplish this very well. If someone is being careful, or either just gaining or re-building their cardio fitness, would it be smarter to put the strides earlier in the run so your HR doesn't go as high? The change would probably be the same, just less overall. I ask because usually I read to do them at the end. .

It is important for you to be fully warmed up when you do any faster running. Strides can be done early on or later, depending on when you like to do them. The keys are: that you are warmed up adequately, have recovered completely after each one, and make sure the form is good during the quick reps. The heart rate doesn't matter. You are doinog them to get used to running faster and more efficiently. In many cases your HR won't even go up that high. I do strides once or twice weekly during 'base' training. This is often the day after a LR (monday) -and I start out at recovery pace>ease into easy pace for a couple of mles and then in the last two miles do 8x20-30 seconds of strides-at the 1/4 mile points-jogging easily inbetween to completely recover. This is my bread and butter 5 mile/~40-45minute recovery/easy/stride day on Mondays (when I have the time). I'll also do strides on Friday or Saturday (after my speedwork on Thursdays) the same way. Occasionally I'll add drills/form work during the last easy mile while out on the roads-like 'high knees' , skipping or 'fast feet'. I try not to do those in my neighborhood too often... find out what works for you and what you like...then do it!

Great post! Thanks for putting time and energy into sharing such good information. I think people often think that if they are fit, they are immune to cardiac issues. Recent news as well as your experience proves otherwise. Though the risk test puts me at less than 1%, I have Type 1 Diabetes. I know you're not dispensing medical advice here, but would just that fact with no other risk factors or symptoms normally lead you to suggest an EKG and/or Stress Test for a 40+ female?