I am scheduled for a cardiac ct scan soon. I am a 31 year old female with anxiety problems and I've had left arm/jaw pressure on and off for about, oh, 7 years or more. I've been to the ER, had EKGs while the pressure was there, had blood drawn to see if there was any acute heart attack or damage happening, nothing. In the last three months I've had a stress test (base model), echocardiogram, about 3 resting EKGs, and blood work. They were all ok. My cardiologist says that he feels I'm fine, but to "put this issue to bed" he's ordering a cardiac ct. They recently got one at the hospital I go to and they love using it. I am on a beta-blocker because I have spells of tachycardia (those have been checked out multiple times, too---just sinus tachycardia). My worry is this: For the cardiac CT scan, the heart rate has to be low (at least under 75, but preferably 50-60) so nearly every patient is given a beta-blocker even if they don't usually take one. OK, the problem being: each time I've had a CT with contrast (I have had them to follow different abdominal issues, and to check for a pulmonary embolism) while I've been on a beta-blocker, I've felt as if my heart rate dropped a lot and I became nervous and shaky. It passed after like 15 minutes or so. I sat up on my gurney and never fainted right after each scan (this was 3 different times), though I don't faint easily, I've never fainted, actually. I've had two CTs without being on beta-blockers and did not have those strange heart slowing and shaky symptoms at all. I'm a nervous person, so I don't know if I'm just overreacting, but I find it suspicious. I mean, if I truly had a bad reaction with those 3 CTs I would have passed out or gotten sicker or something, right? But I have read that beta-blockers increase the chances of reactions to contrast dye, and sometimes people can have "vasovagal responses" to contrast, which means their heart rate and blood pressure drop. I think that's what happened to me, but back then my heart rate was much higher (my resting heart rate was in the 80s even on beta-blockers, now it is in the 50s on beta-blockers). So I'm thinking, well, if my heart rate dropped back then, it still would have been beating at a relatively normal speed, but if it drops now, it will be going dangerously slow. I can't get hold of anyone in the radiology dept. who can really answer my questions. I'm really scared of this and wondering if I should just ask for an alternate test like a thallium stress test (even though my resting heart rate is low, I'm on a very low dose of beta-blocker and I can exercise to my target heart rate). I'm so afraid to go in there and they'll inject me with that contrast and my heart rate will plummet, then they'll have to give me more scary medications. Am I being ridiculous here (I won't take offense if anyone says I am, seriously!) or do I have a valid concern? Being an anxious person, it is sometimes hard to tell. I just don't want to show up for the test and have a technician totally dismiss my concerns only to have a bad outcome.

Well well well if it isn't a fellow "nervous person" from the anxiety boards. lol

Your going to be fine, they wouldn't put you in harms way to check your heart out. Just to have peace of mind talk to you doc or the technician and just level with them. Tell them you have hospital anxiety and your concerns.

You will be fine. You results will be fine.

...everything sounds fine , Panicky Fella (and BTW, panic can be a good thing and protect you sometimes). If they were ordering a cath, I would be more concerned but you have had dye several times with no major allergic reactions. I had a vasovagal reaction during a cath (angiogram) a while back and a shot of atropine did the trick anyway (my HR fell to 32 and my BP to 57 over 44 LOL...felt like I was fainting but was too darned stubborn LOL to die at that time!), should that become necessary. The CT scan with dye is a non event as far as I am concerned (just dreram of giant donuts...)....just always a good precaution and will be a reassuring baseline should you ever develop risky cardiac symptoms.
I don't know why they can't just give you Ativan or something to slow your heart to a normal resting rate (mine is around 60 anyway). I am allergic to beta blockers so what would they do with people like me LOL?
jan
PS Why are you so worried about heart stuff?...positive family history?

Because she like me suffers from anxiety and panic. CS has given me re-assurance in the past over in the anxiety boards and I have read alot of her posts.

I am not answering for her but peace of mind is like gold for people who are very concerned about their hearts.

CS's results will give her peace of mind and re-assurance that her heart has been ok all this time.

Sorry...I am still learning this site and realize I responded to the wrong person....Sorry, Squirrel...and again, has your cardio thought of another way to reduce HR if necessary? My SAT's drop into the 70's with beta blockers.... I know I am strange but why would they use them just to do a stress test? I used to be told to hold all meds....so I could actually achieve target HR.
Sorry again...and good luck on the test. Again, the most important thing is think donuts...:)...
jan

Because she like me suffers from anxiety and panic. CS has given me re-assurance in the past over in the anxiety boards and I have read alot of her posts.

I am not answering for her but peace of mind is like gold for people who are very concerned about their hearts.

CS's results will give her peace of mind and re-assurance that her heart has been ok all this time.

he's ordering a cardiac ct. They recently got one at the hospital I go to and they love using it.

How sad but so true. If you haven't seen MONTY PYTHON'S MEANING OF LIFE you really should. THe vignette called "The machine that went PING" describes the new machine phenomenon perfectly.

Your situation is "laying to rest" a tie in between jaw and left arm pain. Such pain, if it originates from the heart is almost always caused by ischemia due to compromised coronary arteries. THe very best non-invasive (well-almost, a nuclear "dye" is slightly invasive) is the thallium scan. THAT'S what should be used.

For a general look-see the MRI can't be beat but for coronary arterial blockages it is definitely second rate...and MAY not even be covered by your insurance.

High dose beta blockers definitely present a risk especially if used to drive a normotensive's heart rate below 50.

Have the thallium scan and tell the doctor that you are mightily impressed with his new machine, but "perhaps next time!"

How sad but so true. If you haven't seen MONTY PYTHON'S MEANING OF LIFE you really should. THe vignette called "The machine that went PING" describes the new machine phenomenon perfectly.

Your situation is "laying to rest" a tie in between jaw and left arm pain. Such pain, if it originates from the heart is almost always caused by ischemia due to compromised coronary arteries. THe very best non-invasive (well-almost, a nuclear "dye" is slightly invasive) is the thallium scan. THAT'S what should be used.

For a general look-see the MRI can't be beat but for coronary arterial blockages it is definitely second rate...and MAY not even be covered by your insurance.

High dose beta blockers definitely present a risk especially if used to drive a normotensive's heart rate below 50.

Have the thallium scan and tell the doctor that you are mightily impressed with his new machine, but "perhaps next time!"
OMG, I hadn't thought of that Monty Python move in ages. Your points are quite true. Even my husband is a bit concerned, he seems to think that if they find something slightly abnormal or they get less-than-stellar images, my chances of being worried about something that means nothing will increase quite dramatically. My cardiologist had even mentioned a treadmill test with echo before he remembered his fancy machine. From my understanding, he is more concerned that I have some sort of rare anomalous artery than blockage. He conceded that the echocardiogram would LIKELY have found an odd artery or structural problem, but stated that they weren't that sophisticated. Another cardio had ordered and performed my base model treadmill test, and he said that if an echo had been included in that (I assume they compare the echo at rest with the echo immediately after exercise) then he would not order any more tests, because that would almost certainly have shown what he was looking for. I think I will call and leave a message for him and request a treadmill with echo or a thallium treadmill test. I have read, as you said, that the thallium treadmill is excellent for detecting blockages, but I've also read that the test that incorporates the echo after exercise is helpful, particularly in women. Any thoughts? Thank you for your wise reply.

[QUOTE=mr_panicky]Because she like me suffers from anxiety and panic. CS has given me re-assurance in the past over in the anxiety boards and I have read alot of her posts.

I am not answering for her but peace of mind is like gold for people who are very concerned about their hearts.

CS's results will give her peace of mind and re-assurance that her heart has been ok all this time.[/QUOTE}
I'm glad I can be helpful, Mr. Panicky! It is SOOOO much easier to be rational regarding others as opposed to oneself! I enjoy your posts, also. They make me feel less alone, and noone wants to feel alone!

...everything sounds fine , Panicky Fella (and BTW, panic can be a good thing and protect you sometimes). If they were ordering a cath, I would be more concerned but you have had dye several times with no major allergic reactions. I had a vasovagal reaction during a cath (angiogram) a while back and a shot of atropine did the trick anyway (my HR fell to 32 and my BP to 57 over 44 LOL...felt like I was fainting but was too darned stubborn LOL to die at that time!), should that become necessary. The CT scan with dye is a non event as far as I am concerned (just dreram of giant donuts...)....just always a good precaution and will be a reassuring baseline should you ever develop risky cardiac symptoms.
I don't know why they can't just give you Ativan or something to slow your heart to a normal resting rate (mine is around 60 anyway). I am allergic to beta blockers so what would they do with people like me LOL?
jan
PS Why are you so worried about heart stuff?...positive family history?
Thanks so much for your post, Jan. I'm glad to hear your cath turned out well. I'm afraid of heart stuff, I believe, because my beloved grandmother (who raised me) died after years of heart disease. I saw her after a triple bypass, I watched her have a heart attack, I helped care for her after her illnesses, and during her last hospitalization, when my 14 year old brain thought "well, she'll be back home in a few days" I remember, clear as a bell, her doc coming in and saying "I don't understand why you aren't feeling better. Your numbers look excellent." Visiting hours ended, I kissed her goodbye, and she had cardiac arrest a few hours later. My aunt was with her. They brought her back a couple of times, my grandmother was somewhat awake and gave them DNR orders. She arrested again and that was that. My grandmother was a hearty, hardworking woman who had raised a family, worked a farm, she was tough. A few things I can't seem to get through my head, though: she died in her late 70s, which is pretty normal (this was about 17 years ago), she was diagnosed late with type 2 diabetes so she missed out on years of treatment, and none of the medications were as good in her lifetime as they are now. She didn't even have heart surgery until she was about 74 or 75, which isn't young at all. So I suppose her course was pretty standard for an elderly woman with long-standing hypertension and diabetes. I started getting panic symptoms a month or two after her death, they came and went and eventually became very bad 4 or 5 years later. A few years after that, the arm/jaw pressure started. Even though docs tell me the pattern isn't that of angina and that since I've had EKGs while having the pressure and nothing at all showed up, that is very reassuring to them, I still worry. Another reason is because I have a tendency towards spells of sinus tachycardia for no reason (no anxiety, I can have them just standing up out of bed). That has improved somewhat over the past, say, 10 years, as I've gotten to the ripe old age of 31, but my heart can still hit 140 from just standing up, so I take small doses of beta-blockers which help the tachy stuff but drive my resting heart rate low and make me tired and cold. I wore holter monitors and was monitored in the hospital's telemetry unit for the tachycardia a couple of times and all the cardios said "It's JUST sinus tachycardia---beta blockers." OK, that was too long and too sad! But thank you all for taking the time to respond to my silly post.

CS,

Stress and thallium scan is FAR better than stress and echo at diagnosing the cause of chest pain.
Of course there's no reason both can be done with the same STRESS...make it one procedure.

But if they are mutually exclusive then choose the nuclear scan.

It comes down to the fact that an echo cannot see the effect of exercise induced iischemia and the nuclear scan CAN. My stress echo missed a 98+% blocked major coronary artery even in the presence of chest pain from the treadmill work.

CS,

Stress and thallium scan is FAR better than stress and echo at diagnosing the cause of chest pain.
Of course there's no reason both can be done with the same STRESS...make it one procedure.

But if they are mutually exclusive then choose the nuclear scan.

It comes down to the fact that an echo cannot see the effect of exercise induced iischemia and the nuclear scan CAN. My stress echo missed a 98+% blocked major coronary artery even in the presence of chest pain from the treadmill work.
Holy cow, even though you had chest pain it missed it?! I'm leaving a message for my cardio this morning (of course I probably won't be called back until tomorrow or perhaps Monday since it isn't urgent) and asking for the thallium test. I suppose there really isn't any reason they can't just do an echo, too, is there? Sounds as if the base model treadmill test should go the way of the dinosaur. Thanks so much for your reply, and I hope that you are feeling well.

Lenin, when you say chest pain, what do you feel exactly?

Are you saying my dobutamine echo stress test is a flop to see if I have any signifigant blockage?

An echo (ultrasound) provides heart chamber measurements and the doppler (part of echo to visualize heart flow from input to output. Proper test to determine heart size, valve leakage, and pumping efficiency.

It dos not provide any info regarding ischemia (lack of blood flow to heart muscles) unless there is an impaired wall motion condition due to stunned or dead heart muscle.