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In fact, it may even cause more tension and anxiety. Stress is a part of life.


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Stress comes in many different forms; it can be an event, something that happens to us or our response to the event or what happens. Not all stress is negative and what is stressful for one person may not be stressful for another.

While there is no one right way to work through stress, there are negative and positive methods to overcome stress. It is important to use positive methods that improve our health and well-being, and to find what works for us personally when faced with stress. Cigarettes contain nicotine, a psychoactive or mood altering drug.

When a person smokes, nicotine reaches the brain in eight seconds and causes the release of a chemical called dopamine. Dopamine causes feelings of pleasure and relaxation, a sensation the body craves again and again. However, during these feelings of perceived relaxation, the body is actually experiencing increased stress — blood pressure and heart rate increase, muscles become tense, and less oxygen is available to the body and brain.

The feelings of relief described by people who smoke may just be relief from short-term symptoms of withdrawal from nicotine. First, it is important to understand what makes you feel stressed. Being prepared by knowing what causes you stress and how you will positively work through that stress is important in sticking to your goal of becoming and staying smoke-free.

Make a list of situations that make you feel stress. There are some things that may catch you by surprise, but being ready is important. Make a list of activities you will do when you feel stressed. Remember to use activities that promote your health and well-being and avoid negative coping strategies. Try these activities: Stretch.


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Muscle tension is often a sign of stress. Unfortunately, both doctors and laypeople have been taught and trained wrong. I, for instance, was trained to believe in the general utility of stress testing. This was wrong. I was taught to obtain a stress test history, and to be comforted by normal results. Also wrong. I was taught to believe in the power of stress tests to establish safety and identify disease in low risk chest pain patients before they leave the hospital.

Studies of stress tests have rarely used a proper gold standard i. It appears that flipping a coin would be a more sensitive mechanism for detecting CAD than relying on a stress test. Stress tests are also terrible for predicting death or major cardiac events. In , a preventive medicine group published the largest single experience of stress test screening for heart disease, with over 25, men mean age In the nearly ten years that followed the tests, of the men suffered a cardiac death.

Of course, the most important metric for any health care measure is also the simplest: does it help people? The trial randomized diabetics mean age 61 without known coronary disease, a group considered to be high risk, to either have or not to have a nuclear stress test at baseline. After 5 years an identical number of subjects in each arm of the study had suffered heart attacks or death. Can stress tests do this?

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Just weeks before his collapse due to severe three-vessel coronary disease, the venerable Tim Russert had a perfectly normal stress test. They are designed to identify patients with ischemic, exertional EKG changes. Virtually none of the patients we classify as low risk in the emergency department are likely to fit this description. Accordingly, in the handful of studies examining outcomes of emergency department or chest pain center patients after stress tests, the rate of heart attacks and deaths approaches zero regardless of whether the test was positive or negative—and even regardless of whether they had a stress test.

In the rare case where a stress test might be appropriate e. Like many technological staples of modern medicine, it is an idea that we instituted before we ever used proper research to determine whether it would help people.

The Surprising Truth About Stress

Some people are going to have a heart attack, or get cancer, or be hit by a car, and no test will efficiently identify them, not even the ubiquitous and well reimbursed stress test. This lack of certainty is something that both our patients and we will have to live with, and it is something that we should be telling them. However, any test in the wrong hands can be misapplied and its value lost. Stress tests have their limitations, but applying the evidence guides us to rational use, avoiding overreliance on their results.

The reality is that we have bad tests, good tests and great tests. Bad tests add little to nothing to the clinical picture, whereas great tests may clinch a diagnosis for us, avoiding false positives and false negatives. Good tests lie somewhere in between. If applied properly, their results may help us differentiate one illness or injury from another. Unfortunately, there are way too many bad tests, like a WBC count used to detect infection e.

Bad tests are usually not specific or sensitive for anything. Could you complete your career never ordering another WBC count? Sure you could. Could you make it one day without ordering a troponin? Probably not. We need to do away with the bad, take advantage of the great tests and learn how to apply the good tests, based on the available data. Stress tests are not great tests. They fall into the good test category.

If the test is performed in the appropriate circumstances and the results applied in the proper context, the information can be valuable. However, they are far from worthless. There is a long list of bad tests I would axe before I would discard stress tests. Exercise treadmill tests? Also, patients on sulfonylureas may have false negatives, as this class of drugs attenuate ST-segment change, making a standard ETT a waste of time.

So, is an ETT good for anything?

Actually, it is. Such information can be helpful, with respect to risk stratification and in determining which patients should be admitted and which might be safe to discharge for an outpatient evaluation. He had a stress test two months prior. It appears that this may have been a standard ETT. If so, the test performed as predicted. What about nuclear stress tests or myocardial perfusion imaging? Good, Bad, Ugly? It all depends on the context in which the test was performed and how the results are applied. Two Myocardial perfusion imaging studies, such as SPECT single photon emission CT with technetium Tc99m -agents, are actually relatively good for detecting acute myocardial infarction, but are less sensitive for other forms of ACS.

The early data reported lower sensitivities, as many studies were done at rest only. If you add an exercise component to these studies, they perform much better. So, when will nuclear stress tests most likely to detect a patient with ACS? When they are experiencing acute ischemia.

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Nonetheless, if patients have non-diagnostic ECGs and negative enzymes, these tests can help guide us to the right conclusions with little risk of precipitating cardiac events. The negative predictive value of myocardial perfusion imaging is important. A large meta-analysis, J Am Coll Cardiol. Finally, both myocardial contrast echocardiography MCE , investigating myocardial perfusion via micro-bubble contrast injection, and standard echocardiography to assess wall motion abnormalities WMA , as a proxy for perfusion deficits, are both enhanced by a stress component.