Accuracy of Nuclear Stress Test - Heart Disorders Message Board

laura3377 · 03-11-2007, 04:08 PM

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.

Toneman · 03-11-2007, 05:11 PM

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

laura3377 · 03-11-2007, 05:19 PM

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.

pa235 · 03-11-2007, 07:08 PM

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

Pika · 03-11-2007, 08:15 PM

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!