A few questions about tests for chest pain

[tifa]

I am 25 years old, female, been having chest pains off and on for years now. I have had two nuclear stress tests, many VQ scans, and a few years back even had some chest ct's. Recently, I also started having back pain with it. They are sending me for another VQ today at 3. And have mentioned the possibility of testing my aorta. A few questions ...

1. I had a stress test 2 weeks ago or so, should I be having a VQ scan so soon after that radiation?

2. I'm trying to avoid anymore radition from ct so which imaging technique is better for imaging the aorta ... An MRI or an MRA? And should it be ordered with or without contrast? And is it just called a chest mri or mra or should it be called cardiac mri or mra? I am asking because my doctor isn't clear about alternatives to ct.

3. That would just view the thoracic aorta, am I correct? What would be needed to view the abdominal as well? An ultrasound? And is that all that would be needed? A chest scan and stomach ultrasound? Then the entire aorta has been viewed?

4. If someone has a normal Echocardiogram except for trace regurge, what is the liklhood of Marfan's with no family history??? But I do have pectus, long fingers and toes, and very flexible joints.


Thanks so much.

[Cleveland Clinic]

Tifa,


1. I had a stress test 2 weeks ago or so, should I be having a VQ scan so soon after that radiation?

No. However, at some point you are going to have a false positive test. If your testin ghas been negative thus far, continuing to repeat them so frequently will eventually give you a false positive test.

2. I'm trying to avoid anymore radition from ct so which imaging technique is better for imaging the aorta ... An MRI or an MRA? And should it be ordered with or without contrast? And is it just called a chest mri or mra or should it be called cardiac mri or mra? I am asking because my doctor isn't clear about alternatives to ct.

CT and MRI are equivalent in imaging the aorta. The doctor can speak with the radiologist to make sure the appropriate test is ordered.


3. That would just view the thoracic aorta, am I correct? What would be needed to view the abdominal as well? An ultrasound? And is that all that would be needed? A chest scan and stomach ultrasound? Then the entire aorta has been viewed?

Either can. The abdominal aorta is commonly imaged with ultrasound.  The combination of the 2 would image the aorta. Aortic disease would be somewhat uncommon in someone your age unless you have a family history of Marfans or other connective tissue disease.

4. If someone has a normal Echocardiogram except for trace regurge, what is the liklhood of Marfan's with no family history??? But I do have pectus, long fingers and toes, and very flexible joints.

Marfans is a difficult diagnosis and does occur in some sporadically. If there is some quesiton on whether you have Marfan's I would recommend you seek consultation at a center that specializes in treating and diagnosing patients with Marfans syndrome.

good luck

[EchoTech]

Family history would include anybody that has dies suddely under age 50, and another trait of Marfans would be that you are taller than average.  For  a woman, I believe that this is 5'4".  I would second the doctor's opinion in seeking out a center or doctor that specializes in identifying Marfan's.  I can tell you that an echo is useful in that we take extra measurements of the aortic root and ascending aorta.  Good luck.

[tifa]

The doctor responded no to my question about if I should have a VQ scan so soon after stress test?? Because I totally just had this VQ scan today. Is this really terrible? Am I gonna get sick? My doc said it was okay and so did the tech.

[PJmomrunner]

I think the doctor's point wasn't so much as "don't have any more radiation--that's bad" as it was "have enough tests and you will eventually have a false positive"(see mbimom's "64-slice CT post).

My understanding is that an MRA is an MRI with contrast.  Without contrast an MRI of the aorta does not show (or perhaps show as clearly) the delineation of the inner surface of the artery.

I was told by a genetic cardiologist who did assess me for Marfan Syndrome that with no family history of MFS, one major criteria met (aortic aneurysm w/root involvement), and a few minor minor indicators (tall, very nearsighted, wrist thumb sign, flexible), no pectus, no scoliosis, I had about a 12% chance of having MFS.  Genetic testing (~$2K) showed I do not have a FBN1 mutation (which would indicate MFS).  BTW about 1/4 of people diagnosed with MFS have a spontaneous mutation--meaning there is no family history or its occurence, as the doc said, is sporadic.

I

[long]

Would you explain how's aortic root and ascending aorta assessed by echo in identifying Marfan's and what you mean by "extra measurements of the aortic root and ascending aorta." Where you work what are normal upper limits by echo for aortic root at sinuses and mid ascending aorta in a 50 year old men with a BSA 2.05?

[EchoTech]

Usually, just the part right before the aortic valve is measured.  If they are looking for Marfan's specifically, or if the aorta looks larger than normal, then extra measurements will be made.  Typically these are the LVOT, the sinus of Valsalva, the sinotubular junction, and the widest part of the ascending aorta that we can see.  As a general rule, we do not adjust for BSA.  The upper limits of normal for the lvot is 2.2 cm and the upper limits of normal for any part of the aortic root or ascending aorta is 3.7 cm.  Even if they get bigger than that, they typically wait and see if the size stabilizes and try to treat medically.  Otherwise if it is getting big (larger that 5.0 cm sometimes up to 7.0 or 8.0 cm), then they will operate and either wrap it with a a synthetic materail or just cut out the dilated part of the aorta and put in a graft of synthetic material.

[long]

When doing echo on a patient can you tell whether detected upper limits of normal (3.7cm)or higher at sinuses and/or ascending aorta are caused by marfans,other connective tissue diseases,high blood pressure,injuries,infections? There are few echo measurements that I would like to know upper limits of normal for men of 50 years of age with 2.05 BSA. The right and left atrial cavity areas measured in cm2 during systole, Left Ventricular EDV(ml) and ESV(ml), Aortic Valve Max V. in m/sec, Inferior vena cava, and estimated right ventricle systolic pressure?Thank you