What Happens During a Cardiac Stress Test? with Wael Jaber, MD

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials podcast. I'm John Horton, your host. When it comes to gauging the health of your heart, pushing it to the limit can tell you a lot. That's the basic idea behind a cardiac stress test, which forces your heart to pump harder and faster to see how it functions. At peak demand. High-tech equipment used during the test essentially offers a window into your heart and how it works. What might doctors see when they get this performance-based glimpse at your ticker? That's what we'll find out today from cardiologist Wael Jaber, a specialist in cardiac imaging. He's one of the many experts at Cleveland Clinic who join us weekly to demystify medicine. With that, let's learn what your heart might share when it's put under a little stress.

Welcome to the podcast, Dr. Jaber. Thanks so much for joining us today.

Wael Jaber:

Thank you so much, again, for inviting me. I've been looking forward to this for a couple of weeks now. This is a fantastic opportunity to connect with our patients and community, medical community and healthy people. This is a podcast that, again, I listened to five or six episodes over the past few years, a few months, and I really shared it with some of my family members here and abroad. Again, looking forward to a nice chat with you and our friends who are listening.

John Horton:

Well, I'm looking forward to it too, and a big thank you to you for expanding our listening audience, so I love hearing that we're being spread all over the place.

Wael Jaber:

Oh, anytime. Anytime. That's the Cleveland Clinic message, right?

John Horton:

It is, so without a doubt, we are worldwide. In reading up on stress tests ahead of this podcast, it's obvious that we've long known that making the heart work harder is a good way to measure its health, but the way we do it has just changed immensely. I know 100 years ago, doctors had folks walking up and down two steps and measure their heart rate and BP as a sort of stress test. Now, we've literally gone nuclear and the tech just keeps getting more and more advanced. Dr. Jaber, I know you're involved in a lot of imaging research, so where do you see this all going?

Wael Jaber:

This is, again, a very, very good journey we've been along for the past 100 years plus, as you said. Originally, stress testing started as something the Air Force, actually, when the Air Force was constituted after World War I, they wanted to figure out actually who's fit and who's not fit to fly a plane. This was started as an experiment in the Air Force, so they used to get these young fit, of course, often male who are 5'10 to 5'11 normal weight. Back then we didn't have many people with what we see right now with obesity epidemic. Those individuals, they used to put them, as you said, on basically a ladder, almost anything like that, just to climb three, four steps back and forth and back and forth and rudimentary way to measure their heart rate. They measure their blood pressure, their sweating, their exercise level, how long they can go.

Very, very crude I would say in a way, but it actually served the purpose, which is getting the heart to pump harder, getting the blood pressure to go up, getting the heart rate to go up and figuring out if they develop any symptoms and how fit they are. Over time, this has evolved by creation of the treadmill, of course, which everyone is familiar with right now as a form of stress. Then creating the bike stress test, which is another method of getting stress. Predominantly our European friends use it more often and that's clearly why. It's just because they use bikes more often than us and then we go from there. You can have do it supine, recumbent, you can do it standing, you can do it in the cath lab with invasive catheters inside you.

We move from the real stress, which is the most physiologic, simulating what we do every day in life to actually trying to simulate stress tests with pharmacological stress testing by giving drugs in individuals who cannot exercise, who have muscular skeletal problems, let's say a knee or a hip or back issues. They cannot do exercise on treadmills to actually do that in a way where we simulate tests by giving various medications and we do the same almost, we get almost similar results, but we prefer as a cardiology community and as a community of healthcare providers to actually do the real stress test, which is simulating real life.

John Horton:

Yeah, actually moving and getting that heart naturally going on its own.

Wael Jaber:

Exactly.

John Horton:

Well, for those unfamiliar with stress tests, let's start with just some real basics, which is why would someone need to have one and kind of what's the purpose behind it?

Wael Jaber:

Okay, so this is, again, if you're a movie buff, which I am not because I don't have time to watch all movies, but if, remember most of the movies we see or we used to see in the past, they show you an average person either doing something physical then clutching their chest, and then they're either having chest pain or they pass out and unfortunately, die. The most famous movie from Dr. Zhivago for the people of certain age on this podcast, they will remember Dr. Zhivago running after the tram and then clutching his chest and collapsing. That's a form of stress, right? Whereas, Dr. Zhivago on a regular day was not feeling any pain or symptoms. What we're trying to figure out at rest, most of the time the heart, even with blockages in the arteries most of the time can meet its metabolic demand, meaning it can get enough blood supply to supply the muscle and not have any issues.

When it becomes a problem is when you put some stress on the heart and it requires more blood to perform, then this is when it sees itself as lacking in oxygen or lacking in sugar or lacking in nutrients. This is when you start having the chest pain symptoms or the shortness of breath and all these things. With stress testing, we're trying to simulate that. We're trying actually to get you to a point where we can figure out how much the heart is at risk from a blockage or how tight is this blockage and how significant. It's different how we are seeing it by camera versus how the heart is seeing that blockage, and that's the reason behind stress test.

John Horton:

Is it one of those cases where when you're exercising or when you're asking more of your heart, if you have one of these blockages, just that little bit that it kind of reduces that blood flow, you really notice it because you want it at max capacity right then?

Wael Jaber:

Correct, so this is like imagine you having, let's say a water supply to a house and in a general day when just one person is opening that faucet, it's going to be fine. Imagine if you have blockage in that water pipe and you open one faucet, it's going to be enough to supply it. Imagine everybody trying to use the water at the same time in the house, then you start noticing the trickle and then you notice that. This is exactly what we're trying to do, is trying to figure out how much the blood is seeing or how much the blood is reaching the areas of the heart during that stress period versus at chest.

John Horton:

Yeah, I'll tell you, your water example just makes me think of when my daughter visits because let me tell you we have water flow issues because she takes forever long showers.

Wael Jaber:

You go try to open the water down on the first floor and then she would not get water upstairs.

John Horton:

All right, so we're talking about our internal pipes here with the heart. What actually happens during a stress test? I kind of have an image in my head of somebody sweating away on a treadmill and pounding out some miles, but kind of walk us through what happens during one of these sessions.

Wael Jaber:

These are not like the stress tests you see at the gym when people are just running on the treadmill and watching TV and all this stuff, although we can do that, this is a very controlled environment. A person is screened carefully before they arrive to the stress test, usually ordered by a physician who's suspecting something or a healthcare provider who's suspecting something. Then when they arrive to the lab, there is an exercise physiologist present often too. There is a physician in the room or next door, immediately next door. They get hooked up to a bunch of equipment. That equipment depends on the type of stress test, can monitor just the heart rate, the blood pressure, the ECG, the electric activity of the heart, or it can monitor more than that, it can monitor sometimes you see these stress tests where patients are wearing a mask.

This is basically for oxygenation and demand and CO2 and all these things. This we do it when people with heart failure or people with extreme athletes are trying to achieve that. Then we put them on a treadmill or a bike and we start a very low level to figure out where they are and where they're comfortable. Periodically, there is a prescribed timeframe before we increase the speed and the elevation of the treadmill. Then we are at every single tip point almost every minute, every two minutes asking the patient how they feel. There is a very nice scale where they can point to and then they tell us how they feel. We're monitoring at the same time things they're not seeing, which is the EKG, which is the blood pressure, the heart rate, the tracing, all these things are being monitored. Then when we see, either we see something on the equipment we have hooked up to the patient or when the patient feels that they cannot go anymore, this is when we stop the test and we consider it a complete stress test.

John Horton:

Yeah. How hard do you get pushed? I mean, it sounds like there's an awful lot of staff around watching you. I mean, how intense is this exercise session?

Wael Jaber:

If you go to the gym, it's not more intense than the regular gym workout, but we try to get you to the peak of your exercise. Sometimes you go to the gym and you in a rut and you just do the same speed, same elevation, same thing all the time, but here we try to actually challenge you a little bit more. It's like almost taking a test. You're going to get eight out of 10 questions right, but the last two questions are going to be the toughest probably, so this is how it is. It gets, keeps getting faster and higher to the point where you almost need exhaustion, but it's never, no stress tests last more than 10 to 15 minutes because most people cannot exercise beyond that point.

John Horton:

Yeah, I was going to ask you how long they lasted and I take it some of that may depend on the fitness level of somebody. I mean, you have some people can run forever fast and I'd imagine they're a little tougher to get up there.

Wael Jaber:

In elite athletes, which we actually were fortunate, we see a lot of them at the Cleveland Clinic, but in general population, if you take the general population, most people go less than six to seven minutes on the treadmill before they reach their exhaustion point.

John Horton:

Well, and it sounds like if you're messing with the elevation and things like that, that'll wear you down pretty quickly if you start putting an incline on there.

Wael Jaber:

Correct, correct, and then we have the patients who cannot exercise. We talked about it before. These are patients who are either elderly, frail. We try to get that same information without stressing them, of course, physically. They have a hip issue, they have any issue. A lot of patients referred for knee surgery, for hip surgery. The orthopedic surgeon wants to figure out if they can go to the surgery safely by simulating some kind of stress. In those individuals, we have a few medications we can inject. All of them are safe. The risk of actually having a complication during the stress test is probably less than the risk you see at any general gym facility. We do thousands of these stress tests per year. On the main campus here, we do in the range of seven to 10,000, Northeast Ohio, we do 22,000 to 30,000 stress tests per year.

John Horton:

That's a lot.

Wael Jaber:

Probably the event rate is less than one in 10,000 of something happening. I think your risk are just going out for an ice cream is probably a little bit higher than a stress test and more risky in the long run. We do pharmacological stress testing where we inject the substance that simulates exercise. Most of the patients feel a little bit flushed with it, they see a sense of flushing and then it goes away almost within minutes. If it doesn't go away, we can reverse it with another agent and then we get the information. Now, when we combine it with a pharmacological stress testing, we often have to do an imaging test with the stress test. We can get to the point of explaining the imaging testing later on if you want. Most of the tests tests right now, the majority of the stress tests we do, maybe north of two-thirds are combined with an imaging test. We're not only looking at the electric activity of the heart, but we're looking also at the muscle of the heart at the time exercise.

John Horton:

It's so fascinating. With those ones, we use the medication to help simulate the exercise, are you just sitting in a chair when that happens or is that like you're walking on a treadmill and it just helps it seem like it's a little more amped up?

Wael Jaber:

This is question was not planted, so that's fascinating, so you can be done multiple ways. You can be supine in a bed if you are coming from a hospital bed, let's say down for the stress test. You can be in a bed, you don't have to move much. You can be in a wheelchair actually sitting in the wheelchair. You don't have to lay down for this, or you can actually, we can inject you with medication and combine that medication stress test with a very slow stroll on a treadmill. You're just basically going at a very low level. That way we get actually the combined effect of the effect of the medication plus some of the exercise things. Very often we use that exercise part during the pharmacological stress test to get rid of some of the side effects so that flushing will not happen as often. That's actually a method we developed here back in mid-2000s of basically combining these two tests together safely, and that's what we do for some of our patients.

John Horton:

Okay, so as all of this is happening, you're having the stress test, you've got all these people around watching it and making sure everything's going right, they're up in the intensity, they're doing all of this, there just seems like there are reams of data coming in. What are you specifically looking for? I mean, is there something that just jumps out at you when you're seeing these numbers?

Wael Jaber:

For that, it's very test-specific and it depends the question they're asking. The most important value you can get from a stress test is actually the time you spend on the treadmill. The longer you are on the treadmill, the better in general is your prognosis, the better in general is your outcome extending it even 5, 7, 10 years. A person who's on the treadmill for five minutes is going to live a totally different, have a different life expectancy than a person probably who's on a treadmill for seven minutes, 10 minutes. The issue here is the longer you are on a treadmill, the longer you can perform the stress test, the longer is your life expectancy.

That's, of course, adjusted to your age group. We're not going to compare somebody who's 80 to somebody who's 50 or somebody who's 30. Within your age group, if you compare that number, just time on the treadmill, which we transfer to something called METS, metabolic equivalence, that actually tells us more than anything else. That's number one. Number two, if we're looking for blockage in the arteries, then we look at the EKG and the EKG changes in different way when the heart is not getting enough blood. The next issue we look at is we're combining it with imaging. When we combine the stress test with an imaging stress test, we're looking at the heart muscle itself addressed with let's say an echocardiogram ultrasound as it contracts and all the segments, different segments of the heart and the function of the valves. Then we look at that same heart function at peak stress.

If you're not getting enough blood, the muscle of the heart is not going to contract as well, and that we can see right away, or we can look at it with nuclear, as you said earlier with on nuclear, we can look at the exact perfusion, the amount of blood received by every single segment of the heart muscle, and we can quantify that to the milligram and figure out how much the heart is getting blood-stress and how much is getting post-stress.

John Horton:

Wow, so you're measuring the blood flow through the heart, how well it's pushing blood through your heart and through your body to just kind of fuel everything and keep you going?

Wael Jaber:

Correct. We can measure, we can quantify, we divide the heart into 17 segments and we can quantify those segments how much blood is getting per each segment? Therefore, we can tell you actually the blockage is in this artery of the heart, rather that artery of the heart without going inside and putting catheters and things like that.

John Horton:

Now, do you ever have a situation where you have somebody doing the stress test and they seem like a healthy individual, like you said, you got a lot of athletes and people who are in really good shape, but you start this up and you need to stop it. You guys see a blockage or an issue that's right there that really would be hidden unless you kind of did this big imaging test that you're doing?

Wael Jaber:

Right on. What we do is we see we have certain parameters for safety that are predefined. There is a long list of them and, of course, our exercise physios are familiar with them, but mostly it's related to how the person is feeling. If they're having chest pain, they're having shortness of breath, they're about to pass out, all these things are an indication to stop the test. Then we look at all the other stuff that the medical stuff, which is basically how is the EKG doing? Do they have a fast heart rate? Do they have a fast heart rate coming from the right place in the heart? Is it coming from the top? Is it coming from the bottom? Is the EKG changing in a way where it's telling us the heart is not getting enough blood?

The other things we look at is the heart keeping up with the number of beats it needs. Let's say I know John, you're 33 years old yourself, so you should be reaching a heart rate of about 170, 180 when you exercise. If you're trying to reach that heart rate, but your heart rate is not going up except to 80 beats per minute. That means there is a conduction system problem in the heart rather than a blockage in the arteries. We always think about the heart as pipes and arteries and stuff like that, but the heart also is an electric system. It has electricity in it. If there is a problem with the electric system of the heart, we can detect it with the stress test too.

John Horton:

Okay. Well one, you're too kind with the 33, I can barely remember 33, but I'll take it today.

Wael Jaber:

You have very bad short-term memory. That's the problem.

John Horton:

When you do this, like I said, I always think of a lot of these heart issues. We talk about them as silent killers. When you do a stress test, is that kind of a way to find those sort of things that you wouldn't know about unless you kind of put the heart under this sort of duress and really force that information out?

Wael Jaber:

What we're trying to do here is trying to unmask what's underneath that iceberg. The chest pain or the discomfort that the patients see in their daily life, that's the tip of the iceberg. A lot of people are asymptomatic when they have heart disease, and hence what you mentioned about the silent killer. A stress test is trying to get to the two-third of the iceberg that's underneath water, under the water. Sometimes even the patients on a treadmill in a stress test in the lab, they don't feel anything, but yet we see something on the electric stuff or we see something in the imaging. This is what we're trying to do is trying to make reveal what's hidden for the patients. We have a very good way of doing it by stress testing because that gets you almost up to 90, 95% of unmasking all the problems that are there.

John Horton:

I know you said you work with a lot of professional athletes. I also think people in high-risk jobs may come in and have this done, police, firefighters, things like that. There are a lot of times where you have people who look completely healthy, they look like the picture of health, and you do this test and you find something in there that isn't quite right.

Wael Jaber:

This is something we do very frequently, especially on pilots. You mentioned bus drivers, pilots, professional athletes, people with high risk jobs that require even you cannot take a risk in missing something. Yes, that's very common. It's not uncommon for us to see a patient or an individual who's coming here for a checkup, they think, or the perception at least from physical appearance, that they're well, they're fine, but remember just the outside appearance, it can hide or mask a lot of things inside. The risk factors accumulate. Let's talk about some of the risk factors that lead to accumulation of plaque in arteries and stuff like that, which are, most of them actually are asymptomatic silent.

You cannot look at me at my face and say, this person has low or high cholesterol. You cannot look at my face and say, this person have low or high triglycerides. I will not know that by looking at myself. You cannot look at me and figure out if I have high blood pressure or not. You cannot look at me and figure out if I have diabetes or not. All these things are hidden and they are hidden for a long time from most patients and they accumulate plaque in the arteries to block these arteries silently for a very long time, and that's what we're trying to unmask. We're trying to figure out these risk factors, genetics, and most of the common risk factors, hypertension, high blood pressure, diabetes, high cholesterol, lack of physical activity. We're trying to figure out how much they impacted the heart without you knowing about it. Yes, just feeling well is very good. It's important, but doesn't mean you're well.

John Horton:

Yeah, I'd imagine you have some people who are really surprised when they do this and then afterwards you go, "Listen, you are 80% blocked in this one artery," and they would never have any idea.

Wael Jaber:

Yeah, but that scenario is actually very, very rewarding in a way because there's nobody who's upset because you found something that is as malignant as let's say a high degree blockage or something like that. It upsets people that, "Okay, I did everything I can and I'm here," but most people are relieved that you found it.

John Horton:

Okay. Yeah, I bet. I bet.

Wael Jaber:

This is the rewarding part of our job is to inform that or to tell somebody, :Yes, you have blockages, but actually they're not leading to a problem in the heart and therefore, you should work more on the risk factor rather than going for a bypass surgery or a stent or any of these things." We can basically, what we can do is we can restratify the patients and guide their management downstream, let's say we can say some patients will need blockage relief, which is revascularization with bypass surgery, with stents, with all these things. Other patients who have blockages, they don't need anything except risk factor control and they don't need any of this stuff done, so you can actually help the patients guide the treatment in guiding the treatment.

John Horton:

Wow. Now, we've hinted that there are different types of stress tests. If you can, walk us through the different type of stress tests and why one might be used instead of another in certain situations?

Wael Jaber:

Stress testing, of course, most things we have have evolved over time. I think we started with the regular stress test, which is ECG-based, mostly related. We might think the electricity of the heart, but we found out that that test is at best 70%, 70, 75% sensitive in terms of picking up problems. It's a very good test, but it is not an ideal test. It's not going to be getting you to rule out disease in most patients. However, it's still important, even if it's, let's say, didn't pick up disease, but if you exercise in a treadmill, let's say for 10 minutes during a stress test without an issue, that's still important because that tells me that you're going to be fine.

John Horton:

That's the basic exercise one. That's just that maybe if you're just trying to take a quick look, get a gauge on somebody, you might do that one.

Wael Jaber:

Yeah, so most people ask me, "How was the result of my test?" I said, "Let's start first with the minutes spent on the treadmill. That's the most important thing. If you think that spending two minutes on a treadmill during exercise, stress test is very good, that's a bad problem. Let's start with that." Then you take the next level of exercise stress testing is to do a combined imaging with it. We have multiple ways of doing it. We have ultrasound, which basically we look at the muscle of the heart and the valves at stress, and during stress or after stress. You have nuclear, which we talked about, which is basically it's a tracer that tracks the blood flow and it goes and can show us the muscle of the heart at stress and during stress.

Also, with nuclear, what we can do is we can assess the metabolic function of the heart with a tracer called FTG, which is similar to glucose and can tell us which areas of the heart are using glucose more than other areas. Then we have MRI, we can do stress MRI, which is a regular MRI you've familiar with, but that MRI basically measures the muscle function of the heart, measures the blood flow in the heart, measures how much scar you have in the heart. It's a very sophisticated test, and we do that too. These are, in general, the three types of stress testing we do.

John Horton:

It's so fascinating, and I know watching those, I've had an echo done. It's amazing. When you're looking at this on the screen and you're seeing your heart work, it's amazing to get a glimpse at that. This is how you spend your days watching this. This is like you're binge watching. We all watch binge watch TV shows. You're binge watching heart function.

Wael Jaber:

I agree with you, John. This is one of those things that are almost like a miracle that you forget about. Remember, if you have friends and family who have ultrasound for babies and about to have a baby, in the past it used to be like, okay, the doctor will listen to the belly of the mom and figure out what's going on. That's the way we do with the stethoscope. Right now, nobody will be satisfied with that. Assessing their future baby is people will get an ultrasound and they get a 3D ultrasound and they put it in an envelope and they look at it and the same thing, the same evolution has happened in heart disease. The limitations of the stethoscope are there, of course, it's important, but they're there and we figure out with ultrasound, it's just a window on the heart.

You can see the heart in real function as it's pumping blood, as those chambers of the heart, the four chambers of the heart and the four valves are pumping blood and how the blood is passing through them. Is it passing in the right direction? Is it leaking? Is it tight? It's fascinating how we take it for granted now that these things are done, but there's a huge evolution that happened in the past 30, 40 years in that field, and it continues to evolve, but it's just, again, you get desensitized to it, but I thank you for reminding me of that.

John Horton:

Now, who's the ideal candidate for a stress test? Because everything you're saying, I think we all want to know if our heart's working right 'cause without it, we're not going to be here. Who is the person who's going to come in and get one scheduled? Why is the doctor going to say, "You need to come in and have this done?"

Wael Jaber:

Very good question. Extremely important question. People arrive at the stress test, although it's a once area where we do these things. They arrive from different places, different disease points, different disease point, different reasons for the stress test. You can come to a stress that's, let's say the most common case today, if somebody is walking down the street, they say they see a big sign that says you should have your coronaries checked for calcium. You see those signs everywhere.

They go and they check the coronary for calcium. They find they have calcium in their coronaries, which is basically areas where you had a buildup of cholesterol. That cholesterol was absorbed by the body and became calcium. They get worried about that. That doesn't tell you how tight is the area in the heart that's blocked. They come from a stress test from that perspective. People undergoing high risk surgery, let's say a vascular surgery, let's say carotid surgery to open blockages here, blockages in the legs, transplant kidney surgery, abdominal surgery for colon cancer, for things where you open the chest cavity, high risk surgery. Not the regular daily surgery, not cataract surgery, not plastic surgery, not carpal tunnel surgery, just basically high risk surgery. That's the second group. The third group is people who have what we call atypical symptoms. Basically, sometimes they get chest pain, but it's not the chest pain you see in movies.

Sometimes they get short breath, but not every time. That's another population we're trying to figure out is this cardiac or not cardiac in nature? Another population where people come from stress testing, people have hard heart disease, and now we need periodic monitoring for this. Another group, as you mentioned earlier, is athletes who they want to be at the peak performance without much risk. Another group is high risk jobs for stress testing, so you can come arrive from there. These are the major buckets. Of course, within those buckets, there are other areas where we get patients for stress testing.

John Horton:

Yeah, that's such a wide range of people, like you said, from everyone that's got a health issue and maybe they're a little compromised to people who are high performing athletes, and that's a lot of room in between.

Wael Jaber:

That's what we have to tailor. That's why we have to tailor the stress test. When you order a stress test as a healthcare provider, this comes to a pool of us and we review those and figure out if this is the appropriate test. This is not the appropriate test. Is this the test? Because it's very hard to have this knowledge. Let's say you're a general abdominal surgeon. I don't expect you to know which test to order for which disease. All I do is I, we get you order to test in general, and we can funnel those patients down those pathways or buckets to get the appropriate test.

John Horton:

Now, on the flip side, are there individuals who shouldn't have a stress test done, where it's just, it is not really in the cards?

Wael Jaber:

I would say in general, if it's not going to change their management. If you are, let's say healthy, your cholesterol is fine, your blood pressure is fine. You are going out for your weekend run 5, 6, 7, 10 miles, you are riding your bike, you are playing squash, you're playing whatever, and you're feeling fine and your risk factors are controlled. I don't see a reason to have a stress test in that population, but would we benefit of having the stress test? Yes, but it can also, one of the, if it's stress testing can be false positive, meaning it can be wrong in the interpretation. That's rare, but it can happen and that can lead to a lot of testing for a person who's feeling fine, who we're not going to do anything about it anyway, so that's one issue.

The other issue is at the ends of life, so do I need to monitor heart disease and things if I know the patient doesn't have long to live? At the extremes of health and the extremes of illness, if the stress test is not going to change the management, I'm not too worried about it and I don't think it should be done.

John Horton:

Well, what words of advice would you give someone who has been asked to do a stress test and maybe they're a little nervous about doing it? Give us your best, "Hey, this is something that really can benefit you," sort of pitch here.

Wael Jaber:

The stress test, I can reassure people that it's extremely safe. There is a really, and we rarely ever have an issue during a stress test, there is a big group of people monitoring the patient. We never have to call on them. Fortunately, rarely, ever call on them. The risk of something happening, leading, let's say to mortality or death is extremely rare. It's extremely, extremely rare. I've been here for 27 years and I can count probably on one hand over the three, 400,000 stress probably more now, over a million stress tests we've done since I've been here where we had an issue like that.

That's one. If you have a problem during the stress test, meaning an abnormality, we know how to handle it very well, and that happens not infrequently. It happens maybe once or twice a week. That's an indication they didn't pass the stress test and you need something to be done about it. It's not a failure of the test or a safety issue. The test actually, that's unmasking disease. Just come to the test. We do it very often. This is something we do in the high 50 to 60 times a day, at least here on the main campus. Very comfortable. The people who have been doing it have been doing it for a very long time. It's an extremely safe process, and actually you want to be in this controlled environment to figure out there it is a problem.

John Horton:

Yeah, I was going to say, if you're going to have an issue with your heart, when you're pushing hard, you want to be in the cardiac wing when that happens.

Wael Jaber:

Exactly. With all these people around you.

John Horton:

No, that sounds great. Well, Dr. Jaber, you gave us an immense amount of information today and really opened our eyes as to what you can see during this. It is just fascinating how your heart works and does all of this, and you don't even know what's really happening and you kind of watch it happen during these tests.

Wael Jaber:

Thank you so much, again, for the opportunity. This is a very nice conversation. I think every time we think back at it, you don't think about it doing your daily life and you're going through your daily life and daily, but you think back at it and you see how much progress there is in this, how many invasive things we avoided by doing this, by basically non-invasively from outside monitoring you and saying out what's going on. Again, this is a field that's evolving, a field that's very reassuring, but it's very important for the patients to understand that controlling the risk factors is as good or as important as figuring out what's wrong. If you have high blood pressure, please take care of your high blood pressure. If you have high cholesterol, take care of high cholesterol. If you find out you're binging and sitting on the couch a long time, get up and move a little bit. Any movement lowers your risk of heart disease, lowers risk of stroke, lowers your risk of diabetes. It's a pleasure being with you. If there's anything else I can do for you, our patients, I'm here.

John Horton:

Thank you very much.

Think of a cardiac stress test as a monitored workout for your heart to see how it handles extra demands. How your ticker performs can tell you whether you have an issue that might need some attention. If you'd liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.