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Old 03-11-2007, 03:08 PM   #1
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Question Accuracy of Nuclear Stress Test

I am at a loss of what to do about my problem. I have chest pain but I also have costochondritis so it gets confusing knowing what it what. Anyhow, I went to the hospital twice in January because I was feeling short of breath and fatigued. I am a 34 year old female. I do not know family history but otherwise I have no risk factors for CAD - Cholesterol is 174 - LDL 88, HDL 82, Tri 42, Blood Pressure usually around 105/65, etc. I am on no medication for anything - birth control, etc. Well, the first time I was in the hospital they kept me overnight and did a Stress Echo the next day - was told everything was fine. The next week I ended up in the ER again with same symptoms. They kept me again and did a Nuclear Stress Test - was told everything was fine. I went to a Cardio not associated with the same hospital to get another opinion and he said he didn't think it was CAD but would do some other tests to rule out valve problems, pulmonary hypertension, etc. During my follow up with him he said everything was fine. Well, I am still have troubling symptoms and just don't know where to go from here. I think I will have a hard time convincing the Dr. I need an angiogram because of the low risk category I'm in. Also, I worry about the procedure because it is invasive and there are risks. It REALLY troubles me to come on here and read about people having negative Stress Tests and then having major blockages. Do you think this is common? Do these people usually have risk factors? Any advice is much appreciated.

 
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Old 03-11-2007, 04:11 PM   #2
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Re: Accuracy of Nuclear Stress Test

laura,

I understand your concern. I have been in your shoes. I had complete cardiac work ups the past two years both of which included Nuclear Stress tests and both normal. I continued to have pain and discussed the possibility of a cath to my cardiologist as I was still experiencing some chest pain. My cardiologist said she was unwilling to do a cath as I had two normal work ups and had the same risk factors as you, other than being a 48 year old male. She actually said that I should go find another cardiologist because she would not put me through the risk of a cath which has about a 3% risk of complication including death. As a matter of fact, my mother had a cath and it put her into cardiac arrest and she almost died.

Being hard headed, I spoke to a cardiologist at the Cleveland Clinic who after reviewing my results also refused to do a cath and advised very strongly against it, he did not feel the risk out weighed the likelyhood of finding anything significant. He also said "if you keep looking for a cath, you'll find someone willing to take the risk and give you one", that has always stuck with me. Who was I to out guess a cardiologist at one of the nation's leading heart care centers.

In my case I was later diagnosed with RA which affected the intercostal joints in my ribcage and was the cause of the pain. With meds for the RA most of the pain has gone away.

I've heard that the sensitivity of the Nuclear Stress test is around 90 - 95%, meaning that it will catch the disease in as much as 95% of those that have CAD. The overall accuracy of the test is listed as 85% but that number can be understated based on the pre-test probability of those that are refered for the test, most have strong indications of CAD. I was also concerned about the number of accounts I read about in which someone had a normal Nuclear Stress test and then was found to have CAD, but consider this, how many people post messages about having this test and never having CAD develop? It just does not happen, there are thousands of people that have the test everyday with normal results that have no reason to post about being healthy.

Look, I'm no doctor, but if I didn't trust my doctor I would have subjected myself to a very invasive procedure for nothing. I was experiencing pain very similar to what you are from costochondritis. It's your body, you know how you feel so you must act accordingly. If you are really concerned or feel something is wrong, do what you have to but remember there is a risk.

Good Luck!

Tony

 
Old 03-11-2007, 04:19 PM   #3
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Re: Accuracy of Nuclear Stress Test

Thank you so much for the reply. Your response does give me a lot to think about. In addition to the Costochondritis I have I also have had a positive ANA (1:320) so there is the possibility I have an autoimmune process going on. I am going to be seeing a Rhuematologist in April about this. If I feel my symptoms get worse I will let my Cardio know and go from there.

 
Old 03-11-2007, 06:08 PM   #4
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Re: Accuracy of Nuclear Stress Test

I have costochondritis also. I get a lot of chest pain and was told if you push on the area and it hurts it is not cardiac, you cannot reproduce heart pain. My Dr. wanted me to have a nuclear stress done, I talked to my husbands cardio about the test and he said it is not a good test but the best they have until the 64 slice c-scan is perfected. My husband had a nuclear stress, passed and two weeks later had a heart attack due to a 80% and 100% blockage. He had another attack 8 months ago but this was due to a blot clot from the coated stent. He did have nuclear test done before this test also and passed and he has a 60% blockage that we knew of from the first cath.it never showed on the test.

My husband is experiencing the same types of pains I have since he had by pass, soreness, sharp shooting pains etc, his cardio says it is all muscle and nerves. He did a echo on my husband and said if your blood flow, Ejection Fraction, is good it means the blockages are nothing to worry about at this time, just to be watched.

He was in cardio rehab and two men and 1 woman all had stress tests done within three months before their attacks and passed. In fact the one man had one done every year for the last 5 years as part of his routine physical and passed each one, he had to have three stents after his attack. I do not trust this test at all.

Linda
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pa235

Fibromyalgia
Myofascal pain syndrome
Costochondritis
Arthritis, cervical and thorastic

 
Old 03-11-2007, 07:15 PM   #5
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Re: Accuracy of Nuclear Stress Test

I don't trust this test too.... It's wasting time and wasting money!

After few months, the echo showed many abnormal events. The cardio asked to have one more stress test to see the blood flow. I said "NO"! It probably will show the same result as "attenuation artefact"! Plus few weeks later, I would have a massive chest pain (too stresss or over stress heart)! Finally, I had an angiogram. It said all normal, no block artery. It is all due to "artefact" again.... I got to live with: pain, dizziness, SOB, tightness and light headed with the rest of my life! NO MORE TEST!

 
Old 03-11-2007, 07:31 PM   #6
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Re: Accuracy of Nuclear Stress Test

It is true that the Nuclear Stress test is not perfect, no test is. I'm sorry for the difficulties that you and your husband have been through. I still stand by my original statement, this is the best test they have short of a cath and has a high catch rate. Also, although you certainly know of 4 unfortunate people that passed stress tests and had heart attacks anyways, how many other thousands of people had the test without ever developing CAD? You also have to consider the risk factors of the individuals that were given the tests, were they high risk patients or were they low risk? I agree that any high risk patient that passes a Nuclear Stress test and still experiences pain should be evaluated further and I'm sure all cardiologists agree. As you said, this is the best test they have at the time and until something better comes along this will be the test used most of the time. Everyone needs to decide for themselves based on their symptoms as to whether or not to proceed with a cath and take the risk but I have heard of people that have had passed a cath and still had heart attacks, where does one stop? We all know our bodies best and know when something is not right. If you sense a problem then it's up to you. These concerns should be discussed with a physician.

 
Old 03-11-2007, 07:37 PM   #7
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Re: Accuracy of Nuclear Stress Test

I agree with you about the risk factors coming into play. I am considered very low risk so I think that's why Dr's are hesitant to push for any further testing. But as I said before if I continue to have concerning symptoms or anything gets worse I will not hesitate to go back to the Cardio.

 
Old 03-12-2007, 06:14 AM   #8
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Lenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB User
Re: Accuracy of Nuclear Stress Test

laura,

Have a confirmatory ANA run and if that shows equally high have a rheumatoid and Lupus battery (about 5 separatre blood components) run. Do you know the PATTERN of your ANA?

I aso got a 1::320 and I went WHITE with terror because my JOINT pains have joint pains and I grew up watching my aunt's sister cripple up completely with RA over 30 years! But all my other tests were negative and the high ANA never recurred? I guess there was some hidden infection going on that I will never know about.

Should you have an angiogram given all your data? IMO, the answer is a firm NO!

Try some ALLEVE for the costochondritis and DO look further into inflammatory, auto-immune disease testing. You will probably get the same negative results I did...a happy outcome.

Last edited by Lenin; 03-12-2007 at 06:16 AM.

 
Old 03-12-2007, 06:55 AM   #9
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Re: Accuracy of Nuclear Stress Test

Hi Lenin -

Thanks for the reply. Unfortunately, I have had three positive ANA's. The second one was 1:160, third was 1:640 - all were speckled. The Dr. did run a couple more antibody tests on me that came back negative so that's pretty good news. Also, my sed rate and CRP have been checked several times and sed rate is always normal and CRP has been undetectable. I guess I will know more when I go to the Rhuematologist. I have found out I am very low on Vitamin D which Dr. said could be causing some of the bone/muscle pain I feel. I am now on supplements.

As for the heart issue, I am going to hold off on pursuing more tests. I will just keep close check on my symptoms.

Laura

 
Old 03-15-2007, 04:49 AM   #10
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Lenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB User
Re: Accuracy of Nuclear Stress Test

Laura,

It sounds like you definitely have an auto inflammatory response going on.

I'm not sure which antibody tests he tested for, but after 3 rounds of super high ANA's like you are getting, all the exotic antibodies (double stranded DNA, anti-Smith, anti ribosomal P, and the list goes on) should be run.

I tesed 1::320 with a homogeneous pattern and I was in mortal fear of Lupus. But there are so many other conditions, like RA, Sjoergen's Syndrome, Scleroderma, TB, and even some drug reactions that can give such a high ANA.

After 3 tests and that awful speckled 1::640, don't let any doctor blow you off with any nonsense like "you need more Vitamin D." You need an expert rheumatologist to make sure the right tests were done.

I was NEVER so relieved as when I saw all negatives for the Lupus panel.

 
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