64-slice CT Scan negative but 100% blockage in RCA

This is a note to all those out there that might be experiencing angina and thinking about CT scan.

I am 35 y.o. male and had a stent placed in my LAD in Dec. 2002.  About 2 months ago, I started having Prinzmetal Angina followed by exertional chest pains (walking up hill, etc.).  I started the tests, nuclear treadmill, EKG, and ultimately a 64-slice CT Scan.  All came back NORMAL.  But I was still having chest pains and they were getting worse.  My doctor was trying to tell me that it was my GI tract or something else.  But I was all to familiar with the pains from '02.

I spoke with another doctor who insisted that I get an angiogram.  Last Friday, I went in and sure enough there was 100% blockage of my RCA.  I did have collateral flow so no MI but I asked how the 64-slice CT Scan could have missed a 100% occlusion of the RCA.  I was told that there can be "back flow" which can throw off the test.  After the angiogram, they went back and looked at the CT results and said there was something that could have been interpretted as an issue but it was dismissed as a motion artifact.

Anyone else have a similar experience with CT scans?
-Douglas

[tanns]

This is really one of my fears.  I have been having chest discomfort for a year and a half.  I have had tests, tests and more tests.  I had a CT-A and it was normal.   I also had a stress MRI that came back no inducible ischemia.  After 3 cardios in my town and one at the Mayo Clinic, I am beginning to think I am crazy.  These chest pains are so disruptive.

After your experience I wonder if I should be heading back to my doc.

Good luck to you.

[Douglas72]

Thanks for the comment.  Yeah, from now on, if I experience angina with exertion, I am going straight to the angiogram.  Its more invasive but I have lost confidence in the other tests at this point.

Good luck to you as well.

[tanns]

I know that chest discomfort can vary between men and women but what kind of discomfort where you having?   I am having every day discomfort.  It scares the heck out of me.  I have been checked by the cardios, gi docs (2) and treated for costochondritis.   I even agreed, for a while, to be treated for anxiety although I KNEW this wasn't the case.  Of course the SSRI didn't help.

In addition to the chest pains, I can feel a weirdness that travels up my neck into my jaw and is in my teeth on the left side (only, of course).  This daily occurance is what makes my doubt my results but I am driving my family nuts with the insistance that something is still wrong.

I am 35 as well but have a pretty strong family history of heart disease.   Do you have a history?  How did you find out about the LAD?

[jmike1_]

I have stents (5) in my LAD as well.  And my problems started last year when I was 38/39, and the EKGs, exercise stress tests and 64-slice CT Scans never showed anything.  I have had luck with the nuke stress test though.  It has been pretty reliable at showing ischemia and indicating when I have a problem.  I've had so many heart caths (8) over the past year or so that I'm really not anxious to have another one, especially if nothing is found (last two were clear).  So I've decided that when my chest pressure gets significant enough for me to be really concerned (I have some levels of chest pressure every day), then I'll talk to my cardiologist about a nuke stress test to confirm/deny problems.  But, test reliability seems to vary from person-to-person and will certainly vary based on the qualifications of those reading them.  But, I think the key is finding a cardiologist you can trust, and listening to what he tells you while at the same time letting him know when you think something is wrong and ensuring that your concerns are answered.  I think anyone with a strong family history (such as I have) and realistic symptoms should aggressively seek out a good cardiologist.  Good luck!

[RMC32]

35yo here also. Strong family history of CAD. Started experiencing slight left chest discomfort in Feb 07. Had ECG stress test, 64 slice scan. All tests came back fine except for the ECG. There was a slight depression that was borderline. Cardiologist gave me option for angiogram but said I'm prob fine. Two weeks ago had procedure, two stents 99% and 70% blockage found in RCA smaller 40% in LAD that was not stented. Only you know for sure if something isn't right, don't rest until you find out what it is. Douglas72 what things did you change after first stent? Did you resume normal activity? I'm nervous about exercising too hard and finding moderating the beers and food is a tough job. Any advise?

[tanns]

I have had a nuclear stress test, about a year ago now.  It was fine.  In addition to all the standard tests, I had a stress-MRI done at the Mayo Clinic.  They "stressed" my heart with adenosine (NASTY stuff) and then did the MRI.  That was also clear.  I have kind of thrown my hands up in the air.  I am not an anxious, stressed out person and it seems that some of the docs are very eager to put you in that category.  I have seen three cardios in my town and, honestly, none of them have really been much help.  At least listening wise.  One did all the standard tests and then a "told you so" and gave me xanax.  Not exactly what I needed.

I opted for the 64 slice because I was scared of the angio.  My doc fought for me with insurance and they covered it.  Now I wonder if I did the right thing!

Hope you are well and thanks for responding!

[Douglas72]

Tanns:  The feeling was a tightness, burning pressure that sometimes went down my left arm, sometimes was in my back.  You know, one way to differentiate between angina and say heartburn is Nitro.  I found that if Nitro alleviates symptoms, then this is most likely cardio related.  Weird thing is I DON'T have a family history of CAD.  My paternal grandfather died of heart failure but he was 80.  So I am still trying to make sense of it all.  

I found out about the LAD in much the same way.  Chest discomfort with exertion, usually walking uphill.  My (ex)-Wife was telling me it was just because I was out of shape but I knew it was something more.  But the treadmill test indicated some potential problems and the following angiogram showed 70% blockage.  That was 4 1/2 years ago.

RMC32: After the first stent, I lost a bunch of weight (40 lbs), started working out more, cut down on my carbs (mainly pasta) and started the drug regiment (metoprolol, plavix, aspirin, altace, Niacin, Lipitor).  I have since stoped the Naicin (didn't like the flushing) and the altace due to some low-blood pressure issues. I did resume normal activity fairly quickly.  But I think the best type of exercise is just simple walking.  I try to walk 30 mins a day now.

Thanks for the comments!

[rubyhall]

Hello all there,
if you are a heart patient and have shortness of breath even when you walk,you have a blockage which will only get worse.Pease get an angiogram.You cannot even think of stress test on a tread mill because you have complaints walking ! Just go !
My case is exactly like Douglas72(who started this thread).My CT scan two years ago did not show any issues.I was having shortness of breath since last week even while I walked.I went straight to the emergency room 2 days back and had an angiogram taken.My RCA was almost 100 % blocked ! They put 3 stents.My stent in LAD (from 2000) was doing ok.I am just back and feeling great !
What a pattern !
If you have an LAD,the next in line is RCA !
God bless all !

[kziska23]

im a 23 year old female i have been experiencing extreame chest pains that cause me to have shortness of breath and dizziness and nausea i been in the hospital three times. the doctor wont do an angiogram cuz of the risk for my young age. I have a strong family history of CAD. my father had 12 stents and 6 bypass surgery and my sister has a genetic disease as so do i have Lipoprotein (a) is a componet of cholesterol. my sister is so bad that all her arteries are so bad that they had to start replacing with plasctic. shes 41 her first symptoms were when she was 20 she dont have much time. just recently she lost her left leg because of the damage of the arteries. im afraid of this but everytime i have ekg i have sinus arrythemias, and all my heart ct scan with iodine was normal, all my heart enzymes were normal. the pain eases with nitro but the doctor has no idea what is going on what is Lp(a) is a not treating us were are dying with known cause or how to treat. plz help us