i am 32 yr old male been having chest and shoulder pain for a few months, went to the er and they sd no heart problems then my dr did an ekg yesterday and sd it was borderline myocardial ischema. i go to see the cardio. tues should i ask for a cath to be done? im scared i have heart disease?

Cardiac cath can be a risky procedure. They should do a nuclear stress test before even considering the cath.

really. are nuclear stress tests realiabe if theres a problem and of they do find something wrong on the stress test then what? a coworker had a nuc test 6 mos ago and he had a heart attack last week so thats why i thought a cath would be a better choice.

Most doctors wont do a cath without doing other test that are less risky first. I have had all the test done that i can besides a cath, i worry that they might be wrong like your friends but a cath is to risky for me to try just now. If you have a nuclear stress test done and it shows something on it then they will probably want to do a cath.

why is it risky? i heard its the only way they can tell if you have blocked arteries

RC,

Here's a doctor's response to the same questions when I asked him;

Thank's for the quick reply. The nature of the pain is not typical from what you would expect from CAD. It's just a mild dull ached under my sternum. It is never accompanied by any other symptoms like shortness of breath, sweating or radiating to any other part of my body. Not crushing or pressure like at all. When it starts it normally last a few hours and is not constant, just kind of comes and goes and has been going on for about 14 months.

Again, I know these are not typical symptoms for CAD, but the cardiologist wanted to rule out the heart befor we started looking elswhere which is why she repeated the tests. She was opposed to the cath because she feels it does not seem likely enough that she'll find anything significant enough to make it worth the risk at this time based on the total work up, like you said not a high risk in her opinion.

Should I push for a Cath anyways?


CCF-M.D.-MJM
04/14/2006
C2 . be careful what you push for --- you may get it. one indication for cath is to relieve the anxiety of the person who thinks they have CAD. If you keep asking, you will probably get one. Caths are very low risk but not "no risk." If she feels comfortable with the stress test and your symptoms are atypical, I wouldn't push.

Pretty powerful words from a cardiologist. If your EKG shows something that is suspicious, I would agree that a Thallium stress test would be a better first step. It has a high accuracy rate and is not invasive and carries practically zero risk. A cath has a about a 1% risk and I would not want it until I exhausted all other tests.

In the long run, go with what the Cardiologist reccommends.

Good Luck,

Tony

Do some research on here on the risk of a cath. There are many things that can go wrong. I know many people have these done everyday and are fine but there is always a chance that something could go wrong. I would definatly do whatever test i could before the cath to see what they say, then if your not comfortable with the results then see about a cath. Like Tony said, see what the cardio says and go with their advice and if anything go to another cardio for a second opinon, ive been to 4 different ones.

A cardiac cath is risky for a lot of reasons, not the least of which is that they can accidentally stop your heart (I was told that is fairly common) and if you don't respond to the crash cart, you're dead. Luckily, they were able to shock me back to life when my heart stopped during the procedure

In the hands of a good cardiologist, a nuclear stress test will give a very good indication, for most people, as to whether they have severely clogged arteries or not. If you have a positive nuclear stress test, then yes, they will want to do a cardiac cath to find out exactly where the blockage is and fix it with a stent if at all possible (sometimes it's not possible to fix it that way).

It's possible to have a false negative stress test, but that should be rare....arteries can clog up quickly (or a piece of plague break loose) and cause a heart attack, so it's entirely possible the person you know was fine, or had only a mild to moderate blockage (say 50%) at the time of the stress test. They won't do anything to fix a blockage until it's about 70%.

why is it risky? i heard its the only way they can tell if you have blocked arteries
You definetly need to seek a second opinion from a noninvasive cardiologists. There are many noninvasive diagnostic procedures that can be done safely

safety,

what other procedures do you mean?

and a quest about cath for connie, are you awake or can they put you out for it, id rather not know whats happenign if i ever had one.

ron

All the information that is needed to evaluate and treat someone with CAD can be obtained from an echocardiogram -- a noninvasive procedure -- or nuclear imaging studdy -- also noninvasive. A very careful history and complete physical exam are also necessary. The one bit of information these noninvasive studies will not provide is exactly where a given coronary artery is blocked. But since the vast majority of all patients with CAD can be effectively and safely treated with modern medical therapy, there is no need to have this information, because it does not matter. The only time this information is needed is when prolonged medical therapy over a period of months has failed to relieve the patient's symptoms, and a decision is made to have the patient undergo bypass surgery or angioplasty. But my noninvasive cardiologist told me this rarely occur. In a 25 year practice as a noninterventional cardiologist, only 11 of his patients, who number in the thousands, have needed a bypass or angioplasty and none have had a heart attack or died because they did not receive such intervention.

safety,

thanks again i wanted a nuclear stress test months ago but my old cardiologist sd i had to fail the exercise stress test to have my ins cover it bc im only 32 yrs old. so im hoping my ekg that was abnormal now my dr can push for a nuc. stress test thanks for all your help

RC,
A sample of one...ME:

I passed a plain vanilla stress test AND an echoogram after the stress test AND several EKG's with flying colors on spite of what was obvious (to ME) angina pain. I lived with this diagnosis and recurrent pain for several years until I found a GOOD cardiologist who did an angiogram, found a complete blockage of my RCA and opened it, relieving the pain.

Safety,

As I've said numerous times, treating the SYMPTOMS of blockage is possible for many people; OPENING the blockage and being able to toss away the handful of odious, and not undangerous, drugs that one must take to stave off angina pain is the route that most people find preferable.
That anecdotal evidence your doctor has tossed your way smacks as self-serving to amplify his ideas, which are FAR from the mainstream, seem plausible...when they are not.

Anyone, lke you, who CANNOT have an angioplasty for whatever reason, who has to choose between death, CABG surgery, or a handful of BP and anti-anginal drugs, of course has fewer options and then the drugs have more appeal. I too would go the drug route rather than have my chest splayed open.

But to suggest that an angiogram is not necessary becasue all it does is LOCATE the blockage is to say that angioplasty has no place in heart care is silly at best, dangerously misleading at worst.
I doubt one person in 10 would prefer a life of beta-blockers, calcium channel blockers, and nitrates to a 45 minute catheter procedure to open that blockage that the angiogram has precisely located.

what is an angiogram? i see the cardio tomorrow for the 3rd time in 6 mos. 2 irregular EKG's 1 irregular echo (showed and irregular haeartbeat, perfect stress test and 2 follow-up EKG's that showed nothing. BP has been rising and falling for about 3 weeks. went to the ER for nothing last night. had extreme jaw, throat and chest pain for about 2 minutes. when it passed i was sick to the stomach and exhausted. this has happened weveral times in the past 2-3 years but never consistantly. about every couple of months. passes in a few minutes and doesn't happen again for a couple of months. i am so confused. ER made me wait 3 hours and then told me i had another 5 hour wait since they were busy. if it happens again 911 will be called. any advise or knowledge on what this could be?

An angiogram (cath) is a procedure that inserts a probe in an artery of the arm or groin pushing it into the coronary arteries to observe for any blockage and measure pressures.

Quote Lenin: But to suggest that an angiogram is not necessary becasue all it does is LOCATE the blockage is to say that angioplasty has no place in heart care is silly at best, dangerously misleading at worst.

A cath also measures gradient pressures of the valves, internal chamber pressures, pulmonary pressure, etc. To say it is only useful for locating a blockage is a gross understatement. It is very important to determine if there is any pulmonary hypertension, and it gives a better insight into prognosis and treatment especially for people with heart failure.