What should I do?

[lisaloo820]

I am scheduled for cataract surgery.  I had a pre-op physical and they found something on the EKG.  They sent me for a stress test and echo.  All went well except they saw one artery that might be narrowing.  Now they want to sent me to another doctor - a cardiologist who will figure out what I should do/possible angiogram.  I am a highly anxious person.  My pressure goes way up under these situations.  I asked you if anxiety can effect an EKG and you said, YES though the doctors said NO.  Is there any chance my anxiety could've altered the result of the stressecho?  I am physically fit.  I exercise with no problems.  I eat well and am thin.  I have no pain.  How is this possible?  The only thing I do have is anxiety.  What should I do?  

[RCA7591]

"Is there any chance my anxiety could've altered the result of the stressecho?"

--end quote--

No.

Unfortunately with the positive stress test, you will likely need to undergo cardiac catheterization to determine the significance of this finding. Catheterization is the "gold standard" to rule out any significant blockage.

Your other option is a 64-slice cardiac CT scan. However, in light of the positive stress test, the doctor will most likely recommend catheterization to error on the side of caution.

Cardiac Catheterization is an invasive procedure, but the procedure itself is straight-forward, and carries very little risk when performed by an interventional cardiologist with experience. The Femoral Artery is a straight-shot to the left side of the heart, and is the most common entry point.

If you are anxious, you can request sedation (actually, most institutions use conscious sedation on everyone). A cocktail of Midazolam and Fentanyl is generally used.

Keep in mind that the false-positive rate for stress tests is high (particularly in women), and that the imaging may be obscured with attenuation artifacts. Usually, it is the right coronary artery that gives a false-positive result. Other such findings may include "mid-to-distal inferoapical ischemia". Just because the test is positive does not mean you have blockage.

What should you do? First, seek another opinion from an independent cardiologist. If two or more recommend a cath, you should have the cath performed.

-Ryan