Ihd, Meds And Stress Test

[Mike_S]

Presumptive AO with CABG in 2006. There was no cardiac rehab available at any VA in South Florida at that time and I could not afford it on the outside.

That said, after a couple of years I had to do something and bought a gym membership. I did that to practice for the stress test. I eventually did well on the test at 10 METS and higher which reduces any compensation to 10% disability because I require meds. I am on Beta Blockers for one of my heart meds. Those meds keep the heart rate down and it takes much more effort and time to reach the target heart rate. METS = % disability.

I have brought this up each time I have a stress test and they tell me to take the meds. However this skews the results. The target heart rate should be adjusted when these meds are required before the test or let us stop using them when safe to do so for the test.

I feel screwed one more time.

[Chuck75]

It's clear that with a 2006 CABG, you had serious and likely life threatening heart problems.

A successful CABG restores functionality, allows healing, and helps prevent further damage.

It cannot eliminate pre-existing damage. With a 10METS, it's obvious that it worked.

The how and why is partially due to the fact that an average person's heart (before damage)

has significantly more capability than is normally used. For about ten to fifteen years after

CABG an individual may actually have greater capability than was present before a damaging event.

For instance, after completely healing from CABG, I was able to hand dig a 3 foot deep ditch about 100 feet long,

to bury an electrical cable to a back yard swimming pool, something that I hadn't done for a couple of decades.

So, the real question is how well certain parts of the heart function now, remembering that

the heart is capable of some compensation. I have a low LVEF, yet other than strenuous activity,

get along fairly well day to day for my age. It's been almost 30 years post CABG.

It sounds like you will need a more detailed and definitive test than just a basic stress test.

A possible one (The "Gold Standard" no less!) involves heart catheterization for diagnostic reasons,

and includes measurement of pressures and flow inside the chambers of your heart, as well as

blood flow in and around the heart. Unfortunately, it's not cheap, has some risks, and usually involves an overnight

in the hospital. (I recently had one a few months ago.)

If the left ventricle efficiency (LVEF) is below 30%, the VA scheduler rating is 100%

and is independent of the MET rating, due to an "OR" in the reg.

(https://en.wikipedia.org/wiki/Cardiac_catheterization) (to give you an idea what I'm talking about.)

The 10 Mets, if real, is an indication, but not a complete one.

Further, athlete's hearts can have significant differences than everyday ones.

Decades ago, (90's) we had an airman in our office that was "kicked out" of the AF because his heart

did not beat fast enough during a now infamous bicycle stress test. He was a runner,

and using today's standards, would have passed current AF annual fitness stress testing.

And, It's more difficult than it was in the past.

Edited May 13, 2015 by Chuck75

[Mike_S]

My point was the target heart rate should be adjusted because the beta blocker keeps the heart rate lower than it would normally be. People are even told not to take them before a stress test unless the Cardiologist requires it just to save their butt should you have a cardiac event on their watch.

I normally can't work at that pace. Every two years I have another test and I take those as a challenge. I go to the gym weeks before and do more work on the treadmill just to make sure I can do it. I mentioned that to one of the Cardiologists during one of my stress tests and he told me I shouldn't be doing that because it was dangerous. Now I ask, how can that be dangerous if I'm capable of achieving 10 mets? Everything is fixed now.

Next time no meds. I want the real mets number.

[FormerMember]

https://asknod.wordpress.com/2012/10/27/cavc-jones-v-shinseki-diarrhea-vs-loose-stools/

Very simply, VA cannot rate you on the residuals of medications unless it is contemplated in the ratings.

[Mike_S]

I don't think I would call it a residual, it is the intended effect. The drug is used to keep the heart rate low making it very hard to reach the target rate.

The rating is based on the time it takes you to reach the target heart rate on a treadmill using Bruce protocol. There are several 3 minute stages, the speed and incline are increased for each stage until you reach the target rate for your age or your BP gets too high or you have chest pain.

If you can only get to stage 1 the rating is 100%, stage 2 60%, stage 3 30% and stage 4 0% unless you require meds then you get 10%. However if one of those meds is a beta blocker it will affect the test results and patients are told not to to take them before the test (except at the VA). Bring them with you and take them after the test is what everybody tested outside are instructed to do.

During one of my stress tests the cardiologist told me he didn't think I would be able to reach the target BECAUSE of the beta blocker. You are forced to take more time to reach the target and that has a big effect on the rating.

I am just including links for a few articles on the subject, there are many more.

http://www.ncbi.nlm.nih.gov/pubmed/14555886

http://www.heart.org/.../How-do-beta-blocker-drugs-affect...

http://www.ncbi.nlm.nih.gov/pubmed/16874142

[FormerMember]

Look at the Part 4 ratings language, sir. There is where the conundrum is solved. https://www.law.cornell.edu/cfr/text/38/4.104

Read it carefully and you will not see any discussion on medication dos or don'ts. No requirement that says eat meds and come test with us. Anything that is not prescribed-or proscribed- is what the regulation can be read to say. If there is no mention of METs while on the drug designed to suppress it, the clear presumption of regularity ensues and it is presumed that if the good VA Secretary Bob had wanted to insert "while on meds" in the regulation, then by golly he would have. Absent any language, it would seem rational to test you without them as a baseline. Rational is not in the VA's lexicon.

Edited May 15, 2015 by asknod

[Mike_S]

I hope you don't think I was arguing with you. I am thrilled you responded and have your book.

This was an issue I have jonly recently realized. I think it can help other Vets by putting in the same position as other Vets that don't require the drug. We are told at the VA to take ALL of our meds before the test and we do like the good soldiers we are.

I have now given myself the choice to abstain from taking the beta blockers before the exam. I could easily stop the test earlier by saying I was fatigued or had chest pain and receive a higher benefit. The VA will cheat but I won't. I want to know the honest result.