Should You Ask for a Stress Test Physical?Sep 24, 2013
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Scot: Question for you, Dr. Tom. Can I call you Dr. Tom?
Dr. Tom: You can.
Scot: All right. Dr. Tom, so a couple of weeks ago ex-president Bush goes in for a routine physical and ends up walking out with a heart stint because of a stress test. Now I've been to a lot of physicals. Other than turn your head and cough, other than asking me a few questions and looking in my ear, I've never been put on a treadmill for a stress test. This doesn't sound like a typical physical.
Dr. Tom: Now Scot, if you were going to the doc maybe 25 years ago, it's possible they could've offered you an annual treadmill test.
Dr. Tom: They used to do that. They used to do that.
Scot: It's not standard anymore but they used to?
Dr. Tom: Pretty much not standard unless you have a reason to do it. It's really interesting because you would think if I put you on a treadmill test and ran you, then if that turned out great that would mean that you didn't have coronary artery disease. Well, it turns out if you're a healthy person that test doesn't really add anything and it can actually complicate the issues.
Scot: How does it complicate things? I don't get that.
Dr. Tom: It's complicated because you have to test results in the context of the person who's in front of you. So if you have chest pain, you come in and you tell me, "Man, I ran a mile and I was way more short of breath than I usually am or I was actually having this funny tingling feeling in my arm," the test can really help me back up the fact that I think you may have a problem. So it gives me more ammunition to maybe say, "You know what? I need to put you in the cath lab and do an angiogram and see if those arteries are actually blocked."
But that same information isn't very reliable when you're normal. It doesn't add much to the examination and it can, in fact, complicate things. There's such a thing as a false positive result on a test so it's possible that a certain, small percentage of patients, that they would get on that treadmill, they would be totally healthy without symptoms and they would run and do well and you would have an abnormal finding that would then lead you to end up in the cath lab, which is not a completely un-risky procedure and find out you had normal coronaries. And that's really why we don't do those treadmill tests on everybody that comes into the office on an annual physical for screening.
Dr. Tom: So we don't really know exactly what transpired between the physician and President Bush. We just don't know. So it's possible he had some minor symptom that made them think, "You know what? We really ought a put you on a treadmill." In fact, with people that are athletic and are doing well, they are basically doing their own stress test everyday. So, if they were not having symptoms there's really not any added advantage, most studies would suggest, to doing an onsite treadmill test for screening.
Scot: What about somebody who's not healthy and they're just like, "Eh, I just want to make sure everything's okay. Give me that stress test"?
Dr. Tom: That's great. I get that occasionally where I'll have a fairly sedentary individual who then wants to lead the scouting troop up to King's Peak and that's the gentleman I'm going to put on the treadmill and see how he does before I send him off with the scouts, so that the scouts don't have to carry him back.
But I think for the purpose of people that are going in for their annuals, I would say that you don't ask for a treadmill test if you're feeling normal. You can discuss it with your doctor, but anymore we use that test when we have a suspicion of coronary artery disease where we're worried about it. We don't just screen with it. That is, we don't just put patients on the treadmill test just on an annual basis.
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