I am not a medical professional, but rather a cardiac patient which has studied a lot of these issues.
Hopefully Dr Beckerman will be able to respond with more specific information.
I wonder what symptoms are condition that caused you to have 3 stress tests in 3 years.
Max Heart Rate (182), not recommended to exceed MHR, but felt good and tech allowed. ... Also, is it possible that by exceeding my MHR during the stress test that the numbers or indications may have been effected, or skewed?
If you (or the doctor) got the MHR from the 220-age formula it is notoriously for not being accurate. Many people have MHR at are very different from what is predicted. There are a couple of newer formulas that are somewhat more accurate on the average, but still does not give a good job of predicting what any individual will do.
The true MHR is the maximum that you can develop if not limited by angina, physical limitations, or the test is stopped early due to abnormal EKG changes.
BTW the MHR can vary somewhat with different types of exercise.
Different doctors seem to report ECHO data in different formats and some report different parameters. So I am not family with a couple of the terms, but in general the numbers seem to be in the normal range.
Septal Hypokensia is a wall motion defect, although mild in my case. However is does imply some level of occlusion, and in my case possibly LAD associated, and therefor potentially dangerous to ignore.
Here is what I have learned about CAD is that coronary blockages need to reach 70-80% before they cause symptoms such as angina or shortness of breath. But they are stable and typically don't rupture and cause a heart attack. Although they can slow increase.
It is plaques that are in the 20-50% range that can be unstable and rupture. And when they rupture blood clot can form in the artery and cause a heart attack.
Currently there no non-invasive way to detect those plaques.
Studies have show that for people with stable CAD that people that where treated with stents or bypass have the rate of future heart attacks as those that where only got optimum medical treatment. However a number of those in the medical treatment arm did later require stents or bypass when symptoms increased.
Basically stable CAD is when angina only happens during exercise and it is controllable with medicines.
But I am not sure exactly who fits in to parameters of this trial.
Let me give you my history. 4 years ago I had shortness of breath on exhortation and fatigue. I only lasted 4:30 on the stress test. An angiogram showed 70% blockage in the left main and one in a branch off the LAD. So I had a CABG (bypass).
1 1/2 years ago I had a stress/echo. This time I lasted almost 11 minutes. BTW the report indicates that I reached 110% of my "maximum" heart rate.
Also it reported "possible distal anterolateral hypokinesis". The cardiologist said that getting an agniogram was optional. I decided not to get it. My reasoning was based on the trial and that being able to last almost 11 minutes on the stress test it it did not significantly limit my performance.
Last month, for my 70th birthday, I challenged myself to ride 700 miles on my bike. About 1/3 way through I had a regular checkup with my cardiologist. And he said that I guess we can ignore that echo report.View Thread
Additionally, as reported in a recent study, osteoarthritis (OA) was found to be an independent predictor of cardiovascular disease (CVD). The results suggested that osteoarthritis (OA) is associated with the increased risk of CVD.
There is some thought that it is due to reduced activity caused by the pain from the osteoarthritis.
And people with knee OA who have had a replacement has improved CV outcomes.View Thread
The main thing that determine if revasculation is going to be done via stent(s) or CABG (bypass) is the SYNTAX score.
The syntax score is a value computed from the number of blockages and the location of the blockages. It also includes extra points if the blockages are at a bifurcation (split) of the arteries, extra long, etc.
The higher the score the more likely that CABG is the answer.
Besides the score they will also consider other things such as any other health conditions.
While there is a very small risk with CABG, as with an surgery, and the recovery is longer. Research has shown that when the revasculationcan be done by either stenting or CABG that CABG has better long term outcome.
In my case I just had some shortness of breath and fatigue. While I did not have an changes on the EKG I only lasted a few minutes on the stress test.
Angiogram showed 70% blockage in the left main right as it splits to the form the LAD and left circumflex. And another one in a diagonal off the LAD.
Because the blockage was at the split it was practical stent it. So I had a CABG.
With some equipment you can ask them to position a monitor so that you can see the angio process. In my case they could not do that. But as soon as it was over the repositioned the monitor and replayed the video and pointed out the blockages to me.
Here are a couple of sites that explain the angiogram (and other tests and procedures).