Are you a heart attack waiting to happen? The best way to find out is through a simple test called a stress echocardiogram. Paul Connolly takes to the treadmill
According to my 75-year-old father, having a heart attack is a decidedly unpleasant experience (worse, if you can believe, than a Saturday afternoon spent at IKEA). He should know. He’s had two heart attacks – one at 40 and one at 55.
Ever since, he’s been on a crusade, badgering my brothers and me to have our hearts checked. Even though I’ve always looked after myself and never smoked (unlike Dad), I’m still mindful of the fact that, at 37, I’m only a few years younger than he was when he had his first attack. Besides, after seeing him hooked up in intensive care after bypass surgery,
I’m determined never to go through the same thing.
And so it was, after talking it over with my GP, that I got a referral for a stress echocardiogram. It’s a simple test, I’m told, that electronically monitors your heart to identify any weak spots or potential problems. In short, it’s one of the best non-invasive ways to find out if you’re a heart attack waiting to happen.
A week later, I’m stripped to the waist at Melbourne’s John Fawkner Cardiology, watching intently as a sonographer scratches at my chest hair with a disposable razor, creating crude clearings on which to stick electrodes. Good thing it’s not swimming weather yet, I think as she beavers away.
I look like I have a pool-clearing case of mange.
Moments later, with ten round electrodes stuck to my chest and left side, I’m lying on a narrow bed with a transformer (attached to the electrodes and a monitor) strapped around my waist. I’m ready for phase one of the test – an ultrasound of my heart.
I lie on my left side while the sonographer firmly moves a transducer (about the size of a mobile phone) over my chest and side. She explains the device will fire soundwaves into my body (not that I can feel or hear anything) and record their path as they reflect off my heart.
A computer will then convert these movements into moving images (by that I don’t mean emotionally affecting images – though that’s not to say they aren’t) which the doctor will assess.
The ultrasound takes about 15 minutes, by which time cardiologist Dr James Wong walks in to to see if I’m ready for the next part of the test – the treadmill! That’s right: time to get the old ticker pumping. But before I do, he takes my blood pressure (normal) and records my resting heart rate (55 beats per minute).
As I mount the treadmill, Dr Wong tells me this part of the test will determine if my heart is structurally normal and whether there are any blood flow problems when it’s under stress. It can also detect valve disorders, weakened heart muscle function, tumours, clots or abnormal fluid around the heart. While he says many people are referred for a stress echocardiogram after experiencing chest pain, shortness of breath or dizziness, it is also recommended for those with no symptoms, particularly people over 40, and those planning to embark on a rigorous exercise programme.
“People may have problems with their heart and not be aware of them,” he says.
Over the next 15 minutes, the speed and elevation of the treadmill is increased every three minutes: 4.02kmh (12% elevation), 5.47kmh (14%), 6.76kmh (16%), and 8.05kmh (18%). As I pace it out, my eyes are glued to the screen in front of me watching the ragged, digital line that represents my heart rate as it climbs ever upwards. Meanwhile, Dr Wong carefully monitors my blood pressure to make sure I’m not in any trouble.
The top mark we’re aiming for today is just above 155 heart beats per minute.
This is 85% of my maximum heart rate (calculated at 220 minus your age). The plan is to gradually elevate my heart rate to at least ten beats above the target rate, so that my heart is pumping a little harder than it would during normal exercise.
In the same way you wouldn’t pass judgment on a car unless you’ve taken it for a test drive, it seems you don’t judge a person’s heart until it’s been taken around the block at a decent clip. Having breezed through the treadmill component to date, I’m now on to the final stage, running at more than 9kmh with a challenging 22% elevation. As has been the case throughout, Dr Wong asks me if I’m comfortable (the treadmill will be stopped immediately should I struggle at any stage or feel any significant chest pain) and, at this point, I’m breathing heavily so it’s easier to nod. My heart rate is now hovering around 170 beats per minute and even though I’m starting to feel the strain, I’m not in any pain. Even so, I can’t help but think of all those unfit patients who, I’m sure, must find it reassuring to know there’s a team of cardiologists on site.
Before I have time to draw breath and ask the doc if he’s ever seen such a magnificent heart outside of Phar Lap, the treadmill has stopped and I’m back on the table for phase three of the test – the final ultrasound. I’m panting and sweating but the sonographer, clearly, has seen it all before.
Once the final ultrasound is over, Dr Wong points to the monitor and shows me the before-and-after pictures of my heart at rest and at play. They show that my heart valves and chambers look healthy, he says, and my heart wall is contracting in proportion when under stress, which suggests healthy heart muscle.
Although comprehensive results will be sent to my GP, the early signs are good and Dr Wong says the likelihood of me having a coronary in the next 12 months is less than 1%.
It’s good news and I know Dad will be pleased – at least long enough to stop bugging me for another year!
Forty-five minutes after arriving, I’m slipping back into my clothes and thinking about the wisdom of undergoing something as painless and non-invasive as a “stress echo”, especially if it can help prevent something far worse down the line. Dad was right to insist I have the test, although he never warned me about the “mange”.
Now that’s going to itch.
In Australia, heart attacks, strokes and cardiovascular disease kill more people than any other disease, accounting for almost 38% of all deaths. In fact, approximately 3.67 million Australians are affected by some form of heart disease. Experts recommend most people over 40 who have symptoms or have recognised risk factors for artery disease have a stress echocardiogram. The test is performed by a cardiologist, so you’ll need a referral, and costs approximately $400, part of which may be covered by Medicare.
