40 yr old female abnormal nuclear stress-what now

[tinatrussell]

I am 40 years old and on Thanksgiving weekend went to ER with what they said were PVC's and to follow up with cardiologist. In my 20's was disgnosed with MVP. I take Atenelol 50mg daily for past 20 years off and on.

Cardio did echo and stress. Stress was "abnormal". I don't remember what echo showed. But then I did a nuclear stress test which I was told also was abnormal. Doc said to either have cath or CT and I don;t want to do either. After too much reading on the internet I am scared and concerned that I don't really need these tests.

I am not over weight, don't smoke...no one has even checked my cholesterol levels. My grandmother had heart disease but never a heart attack and grandfather had a heart attack but after quad-bypass lived another 24 years and didn't die from heart related issues.

Advice? Should I get a second opinion? Im worried (after reading) that the doc ordered this CT because she has the machine in her office and that some doctors are doing it unnecesarily to pay for the 2 million dollar machine. ugh.

Thank you for any advice.

[calcium539]

Please go and do the tests. I was just like you before my cath. I am an Australian currently working in Indonesia. One day when I was driving through Jakarta I saw an advertisement for a cheap Calcium Scan. I was not sick . I did not have any symptoms. I did the scan and was told my total score was 257 and I am in the moderate risk catogary for a future heart event. I went to Australia and did further investigations. My stress echo was abnormal and my cardiologist insisted that I should go for a cath next morning. I was scared and refused. Later my children made me to do the cath after a few days. They did not find much. They found some minor problems including a 35% blockage in my LAD. They did not do anything. I did not feel any discomfort or pain. I went home after 4 hours. I was only asked to change my life style. All went OK.

[tinatrussell]

Here is an update as I picked up my records from the Cardio:
My first stress test: Electrocardiogram showed 1mm horizontal ST depression in inferior leads. Stress EKG was abnormal. Risk of hemodynamically significant CAD is: HIGH

Holter: Ventricular ectopy was 55 with no pairs nor runs
Supraventricular ectopy was 41
One isolated premature atrial beat: 41 PAC's

Echo: mild MR and mild tricuspid regurgitation
Revealed an LVEF of 65%

1/7
Assesment: CAD- nuclear stress test showed mild lateral ischemia with intermediate probability of CAD

At Nuclear Stress test: EKG was normal
Hemodynamic response was normal and no increased ST segment depressions compared with baseline one ventricular couplet noted
CONCLUSION: possible small lateralischemia and no infarction
Risk of hemodynamically significant CAD is intermediate: Clinical correlation recommended

OK so Occupant none of my decision is about money on my part. I was concerned the doctor might be recomending the CT because the machine is in her office and I read that docs are ordering too many of them partly to pay back the cost of the machine.

I may have typed some of those finding not in the right order..anyway...anyone with thoughts?

[Occupant]

I really don't know what information you can get with a CT-scan that is better than what a nuclear stress test will tell you. I had one done thinking they would do an EBCT-Scan to avoid all that radiation and found out later what it was. In any event, since I had a really high Calcium Score (they said 400 is really, really bad and mine was 1200) I decided to do a nuclear stress test. It came back normal and I thought I needed a stent or bypass right away after the CT-scan. Did I or are you putting the cart before the horse here or is it all about money?

[Flycaster305]

Like Chatty, I have had multiple cath procedures.  They have found serious problems that have been relieved with both stents and very good medications that halted aggressive Cardiac Artery Disease.  My first cath was thirteen years ago, and I'm still standing!
The Angiogram procedure is really quite safe.  Literally millions of procedures are done yearly with a fraction of 1% that resulted in serious problems.  I'd proceed with great confidence.  That being said, you are entitled to a procedure report from your procedures.  I always request the report and go over it with the doctor.  If I were you, I'd get more details.  Certainly, what did the Echo show?  How is your mitral valve?  What did the stress test showm were there suspected blockages?   These procedures are recorded, and you could forward those for a second opinion to reduce costs.
You asked abouth Caths, it's a very benign procedure.  You are given a drug cocktail that relaxes you greatly.  You won't normally have much memory of the procedure, and there is no or very little pain.  The entry into the artery is closed and normally there isn't much of a problem with that.  I had one procedure where I had some blood in my tissues, it looked a lot worse than it was, I got a big purple discoloring.  I'll bet Chatty tells you the same thing.  The hard part of a cath comes afterward when you have to stay still for about five hours and not move your leg. If you have the procedure, bring a good book.  
I think you need more information from your doctor to assure you the procedure is needed. I'd give no credence to internet reports, usually only those with very negative experiences or huge fear factors post on some sites.    

[tinatrussell]

You're right. Thanks again for taking the time to respond :) I think I want to get a second opinion from another cardio who doesn't have the CT scan machine in their office. But i will be quick about it. Can you tell me about the catheter and your experience with it?

[ChatterAlly]

The key word here is 'What if".  It could go the other way.  What if you do not have anymore testing and you should have.  Talk to your doctor more before deciding.  I know this is a lot to take on all at once.  Keep me posted!  Ally

[tinatrussell]

Thank you for responding...Im scared of the amount of radiation of the CT scan, scared of having a reaction to the dye...and with the cath I'm just scared in general ! Hospital, catheter, what if they mess up and I die, what if I can feel it. I dont like to be sedated. ugh. It's all happening too fast and now I have chest pain when before I didn't so I think maybe it's nerves.

[ChatterAlly]

OI also meant to add, maybe this is a wake up call in case you are in need of lifestyle changes.

[ChatterAlly]

In my opinion, and that is all it is, an opinion, I wouldn't hestitate at all.  I was thankful for the doctors wanting a better idea and ordering the caths.  I have had 9 cardiac caths now.  And 2 peripheral caths. I have had numerous Echos and Stress tests.  Tilt table and all. I am not sure what you are reading on the internet that scares you so much.  If I was told that I had "abnormal" stress tests, I wouldn't think twice.  I would want further testing and treatment.  I was also diagnosed with mvp in my 20s.  Had noticed "fluttering" then too.  I was always told I was too young for any real heart problems.  Well, here I am 30 years later with peripheral artery disease, coronaryt artery disease and other things.  I have had a few heart attacks. Have stents in different areas of my body and suffer with small vessel spasms.  Like I said, in my OPINION, I wouldn't think twice. If for no other reason I would have the test just to put my  mind at ease.  Have you discussed your concerns with your doctor?  There may not be anything wrong, but on the other hand?????  Your doctor should be able to talk to you about your concerns.  Take care and have a heart to heart with your doctor. (No pun intended)  Ally