What's wrong with this picture? - Heart Disorders Message Board

zonja · 01-14-2009, 02:08 PM

For about two years now I have complained, on and off, about (1) intermittent chest pain (around chest bone), (2) shortness of breath, and (3) palpitations. For two consecutive years I have had pulmonary function tests (normal), C reactive protein tests (normal), and stress echo tests ("essentially normal": atrial arrythmia and benign PVC's noted). Now, following a sleep study that revealed oxygen desaturation (my low number was 85), I had a CAT image of the thorax that showed perfectly normal lungs but "extensive calcification" of the coronary arteries. So I will now see the cardiologist (again), but would appreciate learning from someone out there what *reliable* tests I might request, given that the stress echo and the C reactive protein both failed to show rather advanced lesions---and in the meantime I felt forced to think that my symptoms were "all in my mind." (Risk factors: post-menopause; father died of heart-attack at 55; have rheumatoid arthritis and take methotrexate for it, which I have read might increase the odds for cardiovascular problems.) Many thanks for any help or suggestion about reliable tests, zonja

Beefsteak · 01-15-2009, 11:14 AM

Hi Zonja,
If you have chest pain, shortness of breath, and calcification of the coronary arteries you might consider an angiogram. This has the best resolution in determining the extent and level of arterial lesions (plaque). On good equipment resolution is about 0.25mm, so the diameters of any lesions can be measured. The 64 slice CAT scan has lower resolution as far as arterial plaque thickening goes (0.5mm) but does show the areas of calcification. The CAT scan is not invasive, since there is no catheterisation, but rather expensive for the information it gives. (The latest CAT scanners provide a much reduced x-ray dose, and are therefore safer.) The nuclear stress test uses a pre- and post- mapping of the coronary blood supply to the heart. First a test is done at rest, which usually shows that all areas of the heart muscle have adequate blood supply. Then exercise on a treadmill is performed and a radioactive dye introduced that adheres preferentially to the parts of the heart muscle where blood supply is good. A cardiologist can then identify the particular heart arteries that cannot supply sufficient blood when the workload is high. This process is a little delicate as you need to exercise right to your limit for best results. The nuclear stres test has no imaging capacity and the heart is just a fuzzy blob.
Hope this helps,
Beefsteak