Correct! They specialize in limbs – that’s why I’m traveling 30 miles to have the best group in the area work on me.
intercst
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When I got chest pains resting at night (long before Chavez, a few years before coronary stents, and age 45/46) I did a stress test at home following a Canadian publication. Step up and down a step until your pulse goes to some level and measure how long it takes come back down. As I got more pain I stopped and drove to the ER in the middle of the night. At the ER they did an EKG and told me I had arrived just in time. During the 10 day stay at the clinic I don’t recall having a stress test.
The Captain
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I don’t think so.
With my first episode of Afib, my daughter hauled me off to our local ER…not because I was in any pain whatsoever and my only signs/symptom was a feeling of a couple of goldfish flopping around in my chest, an “irregularly irregular” pulse, and the characteristic appearance of Afib’s electrical activity on her KardiaMobile gizmo (those good value school fees again!)…but because Afib could be a manifestation of MI (with or without chest pain) One test that suggested that I wasn’t having a heart attack was a troponin test. Levels were normal. After multiple failed attempts to convert me to sinus rhythm, I was admitted for the night. I thought it was overkill at the time but I wasn’t about to argue. Next day, I had a nuclear stress test, which I “passed”…i.e. the imaging showed no areas of cardiac muscle that was not functioning normally. I almost didn’t “pass” in that my heart rate wasn’t quite reaching the number the person performing the test had calculated…and she didn’t want to increase the speed or incline of the treadmill to match what I’d need to do to get out of warm-up mode out on the trail (too bamboozled by all those out of shape, fat Sedentarians to be in charge of a fit middle distance runner currently in training, I reckon)
Anyway neither of those two tests showed any degree of blockage in my coronary arteries…it takes some form of angiography to map that. Not necessarily invasive catheterization as CT angiography is apparently sensitive enough in this day and age to show that…it certainly did mine. I am pretty sure the precise internal anatomy of the coronary arteries is required knowledge before actual stent placement, so I imagine it’s an integral part of either stent placement or CABG. According to my intervention cardiologist, that is.
Of course, if I’d walked in with chest pain, I’d certainly hope that I wasn’t sent home with a couple of rolaids if I didn’t fit the typical clinical picture (which isn’t too far from what could happen, it seems)
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The prefix “interventional” seems to have been adopted by the specialists who intervene with tiny, image-guided tools through minimally-invasive techniques.
Interventional cardiologist – can place stents and even heart valves. An old friend of mine had his aortic valve fixed by TAVR a couple of months before I had mine replaced by open-heart surgery. He was in the hospital overnight while I was in the hospital for 9 days.
Interventional radiologist – treats everything except the heart, including extremities.
Interventional pulmonologist – goes through the mouth into the lungs. DH will consult one to take biopsies of his lung nodules.
These minimally-invasive “interventional” techniques are really amazing and dramatically reduce the stress on a patient compared with surgical (cutting through the skin) interventions.
Wendy
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The first time I went into afib, no pain but I knew something felt VERY different, we went to the ER and were immediately checked in (old white guy with chest issue, go to jail do not pass Go). Cardiologist says we’re going to try to correct this with meds, otherwise we’ll zap you. No stress test for you.
The next day an orderly shows up with a wheel chair and says I have an order to take you downstairs for a stress test. I think, well the cardiologist changed his mind. Have you seen the scene in Lord of the Rings when Frodo makes it to Rivendell and meets with an old Bilbo and Bilbo wants to see the One Ring again, Frodo says no, and Bilbo transforms into a hideous monster for a few seconds? Well, that was Ms. Wolf, except in spades. She gets between me and the orderly and yells there’s no way you’re going to move him! Argument ensued. Loud yelling back and forth. Nursing station head nurse shows up and demands to know what’s going on. More yelling back and forth. Head nurse yells EVERYONE STOP!!! No one is moving until I know what the doctors say (I love head nurses). She leaves, comes back in 5 minutes, no stress test. Ms. Wolf may have saved my life.
Lest you think Ms. Wolf acted out of love, forget it. She wanted me alive because she was thinking there’s no way I’m paying someone to do my taxes when my husband can do it for free.
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As an almost 80 yo I don’t think i could do a stress test. Where i was they seemed popular for 60 year olds.
Once i was in ER, an older gentleman was rushed into my ER cubical to share space. He had flunked a stress test and ended up in ER presumably w chest pains.
Stress tests are stressful–maybe even risky for some patients. And you can probably fall off the treadmill.
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Well, with the passage of time…and the rise in obesity rates…you’ll probably find that they become “popular” (i.e.more commonplace) in an increasingly younger population as ASCVD secondary to craptaculous lifestyle choices becomes similarly commonplace in an ever younger population. Much like, say, cirrhosis secondary to MASLD etc.
Should a stress test be an important diagnostic tool for you, it’s possible to achieve the necessary heart rate elevation with medication. When my “superior” fitness level was acting as a barrier to achieving the magic number in my stress test, and there was a general reluctance to increase the belt speed/incline, I do believe that mention of this option was what added the necessary few beats to get me to their arbitrary measure of work. Sheer embarrassment at the indignity of being treated like an out of shape old wrinkly worked! Thank gawd for vanity!!
Mom was 85 when she developed the first “serious” ailment of her life — endometrial cancer. Surgery at her age was mostly avoided as too dangerous and even if successful not being sufficient extra good life compared to sticking with non-surgical drugs and etc.
Her doc was head of gynecological surgery at UCLA, and rapidly fell in love with her. She arranged for a stress test to prove Mom’s viability. The preliminary prep stuff before stress test went bizarre with the EKG machine whining about “abnormality”. Finally the UCLA head of cardiology was called in. In puzzlement he had her put onto a echocardiogram. The moment the image showed up he shrieked and jumped back a couple feet from the screen, and then turned to her (and me) apologetically and said “I am sorry, don’t be alarmed, but you have the heart of a 35 year old athlete.” Mom did not miss a beat, giggled like a prom debutante of the 30’s and said, “Well I should, I’m the fastest female marathon runner in California over the age of 70!”
No stress test. She woke up after the surgery on the gurney taking her to the recovery room and announced she was bored as hell and ready to go home…..
See where I came from?
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I had a cardiac stress test on 3/10/25, almost 4 months after my open-heart surgery on 11/19/24. I had previously worn a heart monitor for 2 weeks which showed my heart is OK.
The cardiologist needed to get special permission from Medicare since the stress test isn’t typical for someone who just had open-heart surgery. But he knew that I was going back to my 5-day-a-week workout schedule and needed the stress test to make sure I would be OK. The stress test brought my heart rate up to 140 and I was OK with that.
The chart below shows data from my Fitbit watch – my daily life in Steps per Minute. The high points are Zumba classes while the overlaid lower series are my daily walks.
My heart appears to be OK but I need to build up my strength. Still weaker than normal.
Wendy
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I went in for a nuclear stress test a couple months back. Just because I wasn’t sure what I should be feeling after the healing from surgery was done. They decided that the nuc test would be most comprehensive and allow for imaging.
Passed with flying colors and I will say, I am still weak as a kitten about 10 months out. I have been playing with bands since a week after being home. I started dedicated stretching session and dedicated body weight work outs. In last two months now I have been back in the yard moving rocks around. I’d say I am about 1/3 the way back to where I expect to be. (The biggest issue is my expectations are based on being mid-thirties and I am currently mid-fifties, so there is that.)
Although, I will say that all my voluntary diet changes and serious reduction in beer intake has made me the slimmest in about 15yrs…so that’s good.
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What kind of music? 
DB2
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Thanks for sharing your experience which puts things into perspective.
I’m 71 and almost 6 months out from surgery. I’m doing Zumba 3 days a week and also working out with hand weights. (I don’t use heavy weights anymore to spare my tendons and joints.)
I did my first official cardiac rehabilitation class yesterday. There were 4 people in the class. The level was low but I expect to build up over the course of 12 sessions.
Wendy
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Haha… (The kind that snaps you in the face if you slip?)
LOL…you just reminded me of how many times I heard my name said in a disapproving voice during rehab. Seems they do NOT want you testing your limits. 
(My watch said 150hr before the chest monitor told on me to the nurses. I was actually just about to slow down when they noticed.)
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My cardiologist told me to avoid exercise after my surgery. I know from experience that I have to build my strength after surgery quickly or my conditioning will vanish within weeks. So I designed my own program, using common sense but also gradually extending my efforts.
Wendy
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Indeed – be careful. Senator Harry Reid lost an eye in such an accident. Of course, being a lawyer, he sued the band maker.
DB2
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The treads at dh’s rehab were individually set to operate to the treadster’s heart rate. Just as well as I’m sure there would’ve been the potential for a few blown valves otherwise.
One of the reasons exercise prescriptions are set for a seemingly low heart rate is that, in these scenarios, a good many of the exercisers are on beta blockers. What this does in practical terms is to blunt the heart rate response to any exercise work load. If the user is placing a high demand on the cardiovascular system, the stroke volume has to increase to maintain that higher cardiac output. That’s a LOT of extra work for a recovering heart. The objective is to get fitter, stronger, and ultimately faster at that low heart rate. In a nutshell, the foundations of endurance training…that Z2/MAF/low lactate/ASCVD mitigation training that members of this board have read about for the past 3 years or so.
That’s why heart rate monitors were developed in the first place…originally for the Finnish National cross country ski team…and to encourage them to make their “easy” or lower intensity days easy enough so that their hard days could actually be hard rather than increasingly mediocre through inadequate recovery.. Imagine a bunch of young, competitive, high testosterone guys being sent out by their coaches for an “easy” recovery slide. That’d probably last until they were out of sight of their coaches and then one would get ahead, then another etc. Before you know it, they’d be racing.
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I have been on a low dose of beta blocker since I first met my cardiologist last year. I’m doing Zumba 3 times a week and last week my heart rate zoomed up to 164 during a fast belly dance routine. Usually it’s in the 120-130 range.
I felt fine during the class but I’m a little concerned that fast heart rates might damage the valve structure.
Wendy
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Very good Wendy it looks like the Zuma classes and belly dance routines are working. 
I’m pretty sure that the reason treadmills are used for cardiac rehab is the fine control over intensity by virtue of belt speed and incline. When I suggested we spring for a tread for home use as he was coming to the end of his rehab, husband’s response was to the effect that he could go outside to walk. Which is true…but living on the side of a mountain with every direction facing grades of 8%plus, he only had to try it the once to accept my usual adage…“You can listen to me now…or believe me later” as correct. Actually, it took two goes of venturing out, and me having to drive to pick him up for the last 200 yards or so to home.
Tangentially, the purchase was instrumental in me making the move to DIY doctoring and diagnosis too. Treads are fundamentally a pretty boring piece of equipment (as are most substitutes for the Real Thing) and one strategy for my Z2/MAF training was to listen to absorbing podcasts alongside the built in training programmes. That’s how I discovered Peter Attia’s and his guests’ podcasts. Been a worthwhile investment all round for us.
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