I’m told I need the mri plus a chemical stress test. Is the chemical going to raise my hr? It’s instead of running on the treadmill. If one runs their hr is rapidly increasing.

I do have a PM but even when the atriums beat at 250-400 I feel them.

The chemical will increase your heart rate to simulate you exercising. It last about 2 minutes maybe 3, caffeine will counteract the chemical. They will run an EKG during the medication and then either ultrasound or some sort of MRI. I had one done last year because of my back and hip not tolerating the treadmill run.

Probably adenosine, Susan. It's weird and unpleasant when you begin to feel it, which happens about ten seconds after they tell you they're starting to inject it into your IV. It feels like you're falling down a well, and they call it a feeling of 'doom'. It can be managed because you know what it is, why they're doing it...AND.....AND...that it goes away in about another 10 seconds. Very short duration, but it reveals the heart's true waveform much more clearly on the EKG.

Since an MRI takes a while, I would expect they'll use dipyridamole or dobutamine since adenosine is so short acting. And yes, whatever they use is going to increase your heart rate. That's the whole point of a stress test.

The order is for the chemical Pyrophosphate was for a nuclear test they decided not to take.

I had a very bad reaction to adenosine. I immediately got angina and was in the ICU for 3 days. My official diagnosis from the chief of cardiology, was type 2 MI. My bracelet mentions Adenosine as an reaction.

If it’s the same family as adenosine is in the second test, a stress test with drugs, then I will want to avoid this test. I specifically told by the head of cardiology today i can’t take adenosine, yet he wanted me to take the test. He called into the exam room my EP who also told me I will only feel flush and that’s all.

I just google translated my report. The test they want me to take is a stress cardiac mapping with dipyridamole. Is that chemical a form of adenosine? The cardiologist said it’s nuclear but his English wasn’t fluent.



Edited 1 time(s). Last edit at 02/28/2024 10:34PM by susan.d.

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susan.d
I just google translated my report. The test they want me to take is a stress cardiac mapping with dipyridamole. Is that chemical a form of adenosine?

No, they're unrelated.

What side effects (I.e. racing hr) should I expect from dipyridamole and is it similar to adenosine?

Actually I just googled the drug and nuclear scan and some get both drugs. Is dipyridamole a nuclear material?

Ps. I was shocked when this head cardiologist suggested I start amio. Isn’t that the reason for an AV node ablation?

I feel after eating anything with sugar some vibration and a pounding nsr. However I was getting my PM interrogation and although my ventricles were at 63, my upper were 212. Thus the suggestion for amio. I refused. He then gave me a rx for Carvedilol 25mg BID to replace my Cardizem 120 CD and fast acting 60 cardizen when I feel out of breath when my upper chambers on on crack.

I looked it up, it’s for heart failure but it comes with enormous side effects.

Has anyone taken this drug? I’ve haven’t read on this forum anyone who uses it.

I always read the less common side effects because of my sensitivity, I unfortunately win the lotto. The cardiologist suggested it for my dizziness and lighthead symptoms. I’ve been stumbling lately, stumbled down a cement set of steps and really bruised myself and my ankle, bumping into walks or chairs , usually door frames like a drunken sailor. The following less common (I tend to get most) is what symptoms I currently have.

Less common (maybe not for me…horrible side effects)

Ankle, knee, or great toe joint pain
anxiety
arm, back, or jaw pain
blood in the urine
bloody, black or tarry stools
chills
cloudy urine
cold sweats
coma
confusion
cool pale skin
cough
dark urine
decreased appetite
decreased frequency or amount of urine
depression
difficulty with breathing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying position
dry mouth
fainting
fast or irregular heartbeat
fever
flu-like symptoms
flushed, dry skin
fruit-like breath odor
headache, sudden and severe
inability to speak
increased blood pressure
increased hunger
increased thirst
increased urination
itching
joint stiffness or swelling
large amount of cholesterol in the blood
loss of appetite
loss of consciousness
lower back, side, or stomach pain
mental depression
muscle pain or cramps
nervousness
nightmares
noisy, rattling breathing
numbness or tingling in the hands, feet, or lips
pinpoint red or purple spots on the skin
pounding in the ears
pounding, slow heartbeat
rapid breathing
seizures
shakiness
slurred speech
stomachache
sweating
swelling of the fingers or hands
temporary blindness
tenderness on the upper right side of the body
trouble with breathing even at rest
unexplained weight loss
unusual bleeding or bruising
weakness in the arm and/or leg on one side of the body, sudden and severe
weakness or heaviness of the legs
yellow eyes or skin



Edited 1 time(s). Last edit at 02/29/2024 07:23PM by susan.d.

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susan.d
What side effects (I.e. racing hr) should I expect from dipyridamole and is it similar to adenosine?

Actually I just googled the drug and nuclear scan and some get both drugs. Is dipyridamole a nuclear material?

Yes, a rapid heart rate. That's the whole point of a stress test.

No, it's unrelated to adenosine and totally unlike it.

No, it is not a nuclear material.

Quote
susan.d
Ps. I was shocked when this head cardiologist suggested I start amio. Isn’t that the reason for an AV node ablation?

You mean he recommended it now? What on earth for? What's he trying to accomplish?

Yes three times. My upper chambers can go to 350+ and I feel like puking and get dizzy and fall or stagger into things, I feel it and breathing so labored I pause between words at times to suck in air.

I want to confirm I’m not imaging it, I started recording a Kardia strip , as a time stamp to compare to my pacemaker report. I’m spot on usually.

Yes he recommended amio. after my successful AV node ablation, to give me relief. Attached are two episodes and a graph of a month I was in 24/day AV/AT. You can see my hr in the upper chambers were beating fast

[ibb.co]
[ibb.co]
[ibb.co]

It shouldn't matter what your upper chambers are doing. The connection between them and your ventricles has been severed. So your ventricular rate (your pulse) remains normal during all this, right?

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Carey
It shouldn't matter what your upper chambers are doing. The connection between them and your ventricles has been severed. So your ventricular rate (your pulse) remains normal during all this, right?

Susan's second image shows this disconnection: 287/63. The high atrial rate is obviously very symptomatic for Susan. I'm curious as to why the symptoms? I thought that the high ventricular rate was the symptomatic driver, obviously an incorrect assumption.

It's long been known that some people do experience symptoms even after an AV node ablation, but nowhere near the symptoms they'd be experiencing if the AV node was still functional. Susan seems to be one of the "lucky" ones. But resorting to amio seems to me a very harsh solution.

Yep I’m one of the “lucky ones”. Story of my health. I attached the 287/63 for a reason to show it does beat fast and yes it shouldn’t make a difference because my ventricles are at 63, but I won the lottery on symptoms because I feel it and it affects my mobility and quality of life.

Hello Susan
Were you told you are to have a nuclear, or MRI cardiac stress test?

To the best of my knowledge, there are currently four pharmaceuticals that cardiologists rely upon for nuclear stress testing: dipyridamole (aka Persantine), dobutamine, regadenoson (aka Lexiscan), adenosine. These pharmaceuticals do not necessarily increase heart rate; their action is mostly to increase blood flow, possibly though chemically induced vaso-dilation. Have seen many patient test reports demonstrating abnormal findings, where the stress agent did not increase heart rate. Not sure which factors enter the decision process in determining which to use. Most cardiologists seem to prefer Lexisan, followed by a smaller number who use Persantine. Dobutamine seems to be a popular choice for stress echocardiography procedures, when treadmill testing is contraindicated. Stress echo, however, is used for analysis of ventricular wall motion comparison, pre and post stress, but will not provide direct information regarding myocardial ischemia or viability.

After administration of the stress pharmaceutical, a radioactive tracer is administered, either Technetium-99m compound, or Thallium, or Rubidium, each of which acts as a potassium analog in the myocardium. This potassium analog principle might be the same used in MRI: injection of a para-magnetic myocardial seeking compound, administered after the vaso-dilator.

Pharmaceutical nuclear stress testing is used when treadmill testing is contraindicated, or when the patient position needs to be reproduced as best as possible between stress and rest imaging, such as occurs when using PET/CT with image fusion.

Pyrophosphate, tagged with radioactive Technetium-99m, is a pharmaceutical that was once used for skeletal imaging. Incidental findings demonstrated that it also accumulated in areas of myocardial infarction, but it never gained widespread clinical use in this area.

It may also have application in imaging for cardiac AL amyloidosis. Not sure what the current status is for this test. Most of the papers I've seen are pre 2022. One group of investigators reported a potential for false positives, but they also discussed a solution to this problem:
JACC Journals › JACC: Imaging › Archives › Vol. 14 No. 6
Diagnosing Transthyretin Cardiac Amyloidosis by Technetium Tc 99m Pyrophosphate: A Test in Evolution



Edited 2 time(s). Last edit at 03/05/2024 03:50PM by K.F.Smith.

Exactly what you wrote. dipyridamole used plus a nuclear element? I was told it was a nuclear stress test and the chemicals will dilate my arteries. I just can’t take adenosine. I have to make sure it isn’t used.

Tell them you cannot take adenosine. There are three alternatives that they can use; they are fully aware of these. post. All options, risk and benefits, sequence of test, should be discussed with you in detail.

The pharmaceutical nuclear test works as follows: You are attached to an EKG and your vital signs are monitored. The pharmaceutical is administered as per protocol (for example, Lexiscan is given as a rapid 10 second dose followed by saline flush). Also as per protocol, shortly after the vaso-dilating pharmaceutical is administered, the radioactive isotope is administered. The isotope will accumulate in your myocardium in proportion to regional blood flow. Areas of ischemia or infarct will not accumulate the isotope to the extent that normal myocardium will.

The isotope almost never has any ill effects. It's a trace amount that is used for imaging.

After the injection of isotope, will be somewhat of a waiting period. Length varies. At the conclusion of the waiting period, you will lay on a table, with your arms extended above your head. A rotating camera will take a series of tomographic images of your myocardium. Takes about 20 minutes.

You will probably receive the isotope twice. Once at rest, for baseline imaging, the second at stress.

A newer alternative to the imaging procedure I've described is a PET/CT combined scanner. PET for Positron Emission Tomography. The CT portion is taken for image correction purposes. For this test NO iodine is used for the CT. Purely an imaging procedure. For the PET part, Rubidium is infused, which enables imaging of myocardium.

For the imaging phase, both tests, the nuclear camera test, and the PET/CT, are usually very easily tolerated by the patient.

I have had this twice. My kind cardiologist told me it's the equivalent of about 500 chest X-rays. Each time.

[x-ray.ca]

Thanks KF.
I had it done pre afib around 2015. I was fine. But now, post v-tach and other cardiac issues, I’m very sensitive to injections. The first covid vaccine my throat , inside palate, lips started to react like I drank very hot coffee, that burning tingling numbness you get when you drink something burning hot. Same with my iron infusions. I needed Benadryl and steroids. That said, I have to be very careful I’m not getting pharma close in family to adenosine because I already know its an ICU visit.

I can’t ask them or confirm what pharma will be injected. I’m live abroad and I don’t speak the language. However soon I’ll be back to the states and will start looking for a vacation new cardiologist and explain my reaction to adenosine, and take it from there.

I’m realizing PERHAPS my dizziness (I can’t see motion or scroll too fast on the computer or stand up and turn my head without stumbling) is not cardio.

I saw an ENT today. 6 minutes per patient. He didn’t look inside my ear with an instrument. Rather he flashed a pin light while 2 feet away. Said my ears were fine. This started after a kid a month ago shocked something in both my ears unintentionally.

He gave me a test. I laid down and he rapidly pulled me up and down while turning my head. I made me sick. Like I got off a roller coaster. Not that I’ve been in one but I speculate it feels the same. I should had kept my eyes open during the test because he said I’m fine and gave me a referral to see a balance therapist..never heard of this treatment. It seems snake oil treatment. I’ll give it a shot.

Quote
susan.d
He gave me a test. I laid down and he rapidly pulled me up and down while turning my head. I made me sick. Like I got off a roller coaster. Not that I’ve been in one but I speculate it feels the same. I should had kept my eyes open during the test because he said I’m fine and gave me a referral to see a balance therapist..never heard of this treatment. It seems snake oil treatment. I’ll give it a shot.

Was he trying the Epley maneuver for vertigo? Balance therapy is often given as part of physical therapy.

'...I can’t ask them or confirm what pharma will be injected. I’m live abroad and I don’t speak the language. However soon I’ll be back to the states and will start looking for a vacation new cardiologist and explain my reaction to adenosine, and take it from there."...

You could do what we all do: say loudly, but sloooowwwlly, 'Ah DEN OOOhhh seeeeen!" while you wave your hands across each other and shake your heads sideways. Even a dolt will catch on to that.

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he wouldn’t know that gloaming. I performed a pantomime like I’m a drunken sailer to show him how I walk around bumping into things. When in the ER I point to my heart and moan. It’s the only communication I have.

I should of had that Epley test with my eyes opened. I closed them because I was too dizzy. He was watching my face. Why couldn’t he use that instrument that goes inside the ear canal? He was so far away it was like a zoom appointment.

A child shoved something into my ears that started this. He says my ear drum were not torn but how would he know from looking with a tiny flashlight so far away?o

Hope everything works out well for you Susan!