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Sarah's Stresstest Misadventure (Part 1)

"Okay, Sarah," the doctor said, "Nurse Ari will get you all set up now, and I'll be back in a few minutes." The doctor clicked the door behind her as she left the exam suite.

-----

Sarah was visiting SMC's Heart Centre as part of a regular checkup. Her doctor had recommended that she undergo a cardiac exercise test this time, and mentioned it as she completed her exam.

"Well," the doctor had said, ripping off the bp cuff, "everything looks ok. You may be showing a slight hypertensive tendency, but we'll keep an eye on that. You're at the age that a stresstest is a good idea." She looked at Sarah, who had yet to get dressed.

"You can get dressed, honey. Do you know what a stresstest is, Sarah?"

Sarah shook her head as she slipped her bra back on. "No, I don't."

"It's pretty simple. You'll just get some exercise on a stationary bike while we take your blood pressure and get an EKG. It's like going to the gym, only we'll monitor your heart while you do it."

It seemed weird to Sarah, and a little embarrassing. "Do I have to...what do I wear?"

"Oh, you can wear workout clothes. We can give you something if you need it. The nurse will get you all scheduled."

-----

Now Sarah was about to get started. She had changed into the special bra the nurse had supplied, and otherwise wore the leggings and sneakers she had brought from home. She was sitting on the edge of the exam table, right across from an exercise bike with an oversized seat and some wires attached to it.

"Just relax, Sarah," Nurse Ari soothed. "I'm going to get the monitors on you and then we can get you up on the bike. First, EKG."

The nurse peeled several white pads from a paper backing and pressed them to Sarah's skin. Two went on her shoulders, and two onto her chest, just above the edge of her bra. Ari rubbed them in a circular motion as she pressed them down.

"Just to make sure they stick, sweetie. You'll probably get a little sweaty." She then snapped a wire into place on each one, attaching the other ends to a thick cable that she clipped to the waistband of Sarah's yoga pants. "Okay, you're hooked to the EKG monitor. See?"

She pointed to a screen on the front of the bike, where Sarah could see a couple of green lines bouncing. "That's your heartbeat, sweetie," the nurse said. Sarah found it fascinating.

"Let's get the bp on you now." Ari produced a maroon blood pressure cuff that she wrapped around Sarah's right bicep. The fit was firm. "A little tight, so it won't slip off. That okay?"

"Yes," Sarah said, quietly.

Ari looked at her. "You'll be fine, sweetie. You look strong and healthy. Okay, up on the bike now; I'll help you."

Together, with Ari managing the wires and the cuff hoses, Sarah got herself onto the bike saddle. Ari pulled what looked like a seatbelt across Sarah's lap and secured it in place. "Believe it or not, this is so you won't fall off. Can you reach the pedals ok?"

Sarah felt very awkward. "Yes, they're ok."

Just then the doctor returned. "Ah, excellent. Just about good to go. Are you ready, Sarah?"

"I guess so, doctor." Sarah smiled weakly.

"Ari," the doctor said abruptly, "let's get the vo2 mask on her as well; I'd like respiratory measurements. "And let's get a puncture for blood gases; we'll run an IV for meds access as well."

Ari nodded. "Coming up. Sarah, I'm going to put a mask over your nose and mouth, ok?"

Sarah began to worry. "What's the mask for? To help me breathe? And what are...blood gases?"

The doctor spoke as Ari brushed Sarah's hair from her face. "Relax, honey. You'll breath normally, and this mask will measure your breathing. If you have any trouble, just speak up. Don't worry, Sarah, this is all perfectly normal. And we're just going to put in a little IV so we can draw blood when we need to as you exercise."

With that, Ari pressed a blue plastic mask to Sarah's face, the soft edge squeezing the skin around her nose and mouth. Ari stretched some straps around the back of her head, and with a click and a slight tug, Sarah was wearing a mask with a little tube and a wire coming out of it.

Sarah felt more than saw the IV puncture, as she couldn't bring herself to watch. As soon as she felt the needle go in, she had a wave of light-headedness sweep over her. Awkwardly, the bp cuff inflated just then, and she felt even more uneasy.

"She's all set." Ari said.

"Okay, let's go." The doctor said, suddenly. "Sarah, we'll start slowly, and the effort will gradually build up. Are you ready?"

"Yes, doctor," Sarah said, her voice muffled by the mask.

She began to pedal.

(To be continued in Part 2)

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Sarah's Stresstest Misadventure (Part 2)

(Catch up with Sarah's story from Part 1.)

There was a bead of sweat running down from Sarah's armpit toward her elbow. The spot where the blood pressure cuff was inflated against her arm was a wet, sticky line. This was harder work than she had expected, and her heart was beating heavily against her chest.

She pedaled, now against heavy resistance, as the doctor watched her vitals on the monitor. Occasionally she pressed the bell of a stethoscope to Sarah's sweaty back to listen to her lungs.

"Doing okay, Sarah?" The doctor asked, raising her voice over the sound of the ergometer's spinning.

Sarah exhaled heavily into the vo2 mask. She nodded her head sloppily and gave a meek thumbs-up with her left hand as the doctor had instructed.

"Okay." The doctor turned to Nurse Ari. "Two more minutes and we'll cool her down."

Sarah heard that and renewed her effort with some urgency. She also felt a sudden need to pee that distracted her.

Within a short time it was the end of the test. "Great job, Sarah, let's slow it down, now. Ari, can you get a BP?

Nurse Ari wrapped a fresh cuff around Sarah's left arm even as the sweaty one on her right stayed inflated and tight. Ari pressed the bell of her steth into the crook of Sarah's elbow as she inflated the cuff. In a moment, "One-ninety five over one-oh-five."

The doctor considered that with a slight frown as Sarah came to a complete rest. She was still hooked up to the EKG and wearing both BP cuffs. The doctor turned to Ari. "With her max pulse of one-seventy-five...let's rest her and check recovery in a few minutes. Sarah," she said, "Ari will help you onto the exam table so you can recover, and I'll be back in a few minutes."

"Can I take these off?" Sarah asked, holding out her arms.

"Not quite yet, honey. We want to monitor your recovery." And she left the exam room.

Ari helped Sarah get down off the ergometer saddle, undoing the seatbelt restraint and walking her to the exam table. With some difficulty, Sarah managed to get her bottom up on the table and pivoted, swinging hoses and wires around so she could lay back. The mask was still on her face, and she breathed through it, roughly, her breaths coming in strong rushes as she struggled into place. The paper on the table crinkled under her and stuck to her sweaty skin.

Ari patted Sarah on her arm, over the inflated BP cuff. "We'll get you cleaned up soon, sweetie."

-----

Sarah was staring up at the ceiling, listening to her own breathing and the beeping from the EKG monitor when the doctor walked in. She turned her head on the table, looking sideways at her and Ari.

"Sarah, we're looking at some irregularities in your stresstest results."

Sarah felt a lump in her chest, and she could feel her heart begin to race. Obviously, the doctor could see that, too.

"Oh, nothing immediately serious, honey, don't worry. Your heart was working really hard during that test and we're interested to learn why."

"Am I okay?" Sarah asked.

"Sure, Sarah. I'm concerned about what looks like hypertension combined with high heart rate at the peak of exercise. I'd like to look a little more closely at your cardiac performance to be sure about what we do next." Turning to Ari, she added, "Let's get her cleaned up and move to the CCU Lab. I'll want to get her on a treadmill for an extended workup."

Sarah's stomach knotted up. "More tests?"

The doctor turned back. "Sarah, this time the exercise will be low-impact, with closer monitoring. You'll walk on a treadmill for a little longer period with some short jogging intervals in between. We'll be monitoring you the entire time, and you can rest when you need to. Ari will get you cleaned up and you'll meet me in the Cardiac Care Unit Lab downstairs. They have the right equipment."

Ari had already started to remove the monitors, peeling the sweaty EKG electrodes from Sarah's chest. They stung a little as they pulled away, leaving a sweaty ring around each location.

"Will I have to wear a mask again?" Sarah asked, as Ari removed one of the cuffs. The sound of the velcro echoed in the small room.

"Yes, and this one will be a little different, a little more comfortable. You'll also wear an EKG and a BP again, and the IV for meds. We'll have some technicians helping us with the test as well. Don't worry; I'll see you in a little while." And she left again.

Ari ripped off the second cuff. "I'll be with you the whole time, sweetie, don't worry." And she smiled.

Suddenly the doctor peeked back in. "Ari, please check with CCU Inpatient; I might want to look into overnight monitoring for her. Thanks."

And with that, she was gone again.