heart stints

[DocVikingo]

Hi fishoutawater,

The answer is, "it depends."

There are number of modifications of the Bruce protocol. The basic form is conducted in 3 min stages where each increases both speed and grade/slope so as to result in 2-3 METs greater workload with each stage.

Stage 1 is a speed of 1.7 mph and a grade of 10 degrees.
Stage 2 is a speed of 2.5 mph and a grade of 12 degrees.
Stage 3 is a speed of 3.4 mph and a grade of 14 degrees.
Stage 4 is a speed of 4.2 mph and a grade of 16 degrees.
Stage 5 is a speed of 5.0 mph and a grade of 18 degrees.
Stage 6 is a speed of 5.5 mph and a grade of 20 degrees.
Stage 7 is a speed of 6.0 mph and a grade of 22 degrees.

The protocol continues until one of multiple possible endpoints is reached. These include a predetermined endpoint such as Target Heart Rate or Stage Goal, hypo or hypertension, fatigue, dyspnea, certain arrhythmias, or gait problems.

If one were to complete the entire protocol, the total time would be 21 mins. Don't even dream of attaining that ; )

To complete Stage 4 (13 METS), the total time would be 12 mins.

Clear?

Regards,

DocVikingo

 

[fishoutawater]

Thanks for that Doc. Does clear it up somewhat.
Currently I can chug along at 6.5mph for thirty minutes, but at only 3% incline, just because someone told me 3% roughly translates to level ground running. I haven't been challenging the higher grades yet. The treadmill has a heart rate monitor which says my pulse is around 150bpm while running at that pace.
But each and every mile I cuss a lot, because not once have I ever worked that hard scuba diving. Even surf entries in Socal aren't as taxing as that damned treadmill is.
I still don't understand why a requirement of 13 METs is mandated by the med community for a return to diving after stent surgery. Especially when I consider the shape of some of the divers I shared the boat with down in Jamaica last week. No current, bathwater warm. Some of them got winded just climbing back into the boat.
But I can't complain too much. I'm starting to lose some serious weight. Who knows?Maybe I'll buy me a speedo. (KIDDING)
Thanks again for that protocol. I'll start working on it as written.

 

[DocVikingo]

Hi fishoutawater,

The 13 METs standard is commonly cited by the scuba med community not just for return to diving after stent surgery, but also after other cardiac procedures and events, e.g., valve repair/replacement, bypass, angioplasty, myocardial infarction.

While I agree that scuba rarely demands an exertional level of 13 METS, on occasion it can, such as bucking sustained heavy currents, perhaps unanticipated. Moreover, being able to tolerate 13 METS without worrisome signs or symptoms tells the physician a good deal about the general health of the cardiovascular system, independent of whether the patient is going to need to be able to perform at such an exertional level in recreational activities.

Finally, this standard generally is not taken as an absolute mandate. It is better viewed as a clinical guideline to be used along much other information regarding the diver's fitness for scuba.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Regards,

DocVikingo

PS: If you get into a Speeedo, please post a photo ; )

 

[Dr. Doug Ebersole]

Fishoutawater --

Sorry I haven't gotten back to you, but I've been seeing stent patients all day and, therefore, not on the board All kidding aside, I agree with everything DocVikingo said (as usual!). The 13 mets is a good guideline and, you're right, there's a lot of people on dive boats who couldn't come close to that level of exercise.

Doug

 

[pir8]

Out of curiosity, are there other ways to achieve these METS. My knees aren't that good so I don't run. I do swim laps. Carry scuba gear down and back up hills.

 

[Dr. Doug Ebersole]

Yes. There are various charts regarding various activities. Examples:

2-3 METS Walking at 2mph
Clerical work
Playing billiards
Driving a car

4-5 METS Walking at 4mph
Light assembly work
Doubles tennis
Painting

6-7 METS Walking at 5mph
Construction
Singles tennis
Yard work

8-9 METS Jogging at 5mph
Digging trenches
Touch football
Sawing wood

10-11 METS Running at 6mph
Lumberjack work
Squash

I even saw a "study" one time that reported sex with your usual partner required 2 METS while sex with a new partner required 6-8 METS. Doesn't speak well for the institution of marriage does it? By the way, I hope my wife isn't reading this!

Doug

 

[DI_Guy]

Debersole or Docvikingo.... question for you ...

As I mentioned before, I just had a CABG (triple) because of a 90% stenosis of the left main CA. When I did the stress test (pre-op) I did not do well because the angina pain peaked and the test was aborted. I believe I scored a -10 . Do you think this was using the Bruce Scale ?
I thought that I read somewhere that a score of -10 means there is a 95% chance of a major MI within 2 years. Am I right. If so, I am one lucky fella.

 

[hyperbaric_1]

And the last one is how much risk are you willing to contemplate? We all make risk-benefit decisions every day, and each one is personal.

This could be the best advice ever. It could (and probably should be) applied to our day-to-day decisions as well.

 

[Dr. Doug Ebersole]

DI Guy:

You're probably talking about the Duke treadmill score of -10 which is indeed bad. It's based on time on the treadmill, symptoms, and ST segment changes on the EKG. Today's approach is more aggressive than in years past because of balloons, stents, etc. In the days where the only options were medications or bypass surgery the main reason for a heart cath was in preparation for bypass surgery. The Duke treadmill score was helpful as a risk stratification tool to decide on cath in that scenario. In today's environment almost everyone who has an abnormal treadmill (regardless the score) will have a cath for diagnosis and possible interventions (stents or bypass surgery).

 

[DI_Guy]

DI Guy:

You're probably talking about the Duke treadmill score of -10 which is indeed bad. It's based on time on the treadmill, symptoms, and ST segment changes on the EKG. Today's approach is more aggressive than in years past because of balloons, stents, etc. In the days where the only options were medications or bypass surgery the main reason for a heart cath was in preparation for bypass surgery. The Duke treadmill score was helpful as a risk stratification tool to decide on cath in that scenario. In today's environment almost everyone who has an abnormal treadmill (regardless the score) will have a cath for diagnosis and possible interventions (stents or bypass surgery).

Thanks Debersole for your quick reply. Your info clears up my confusion on my score of -10. I'll do some searching for information on the DUKE rating system. I have decided to buy a high end tread mill to assist with my recovery. I have a goal to achieve over the next 6 months so I may as well start now. I am scheduled to see my Cardiologist in February.
Thanks again for your help.