Abnormal Nuclear Stress Test

I have been having PVCs for the past 10-15 days and I went to see my primary care doctor to make sure that was not serious.  He did an EKG - said it looked abnormal and referred me to a Cardiologist (to see on the same day).  The cardiologist put me on a 24 hour portable EKG machine to monitor the palpitations and prescribed a Echocardiogram and Nuclear Stress Test to be done the same week.  I got both of them done last week.  He said the echo looked fine, but the EKG under stress was abnormal.  The pictures taken after the treadmill walk apparently also showed that some part (about 10%) of my heart was not receiving enough blood.  He thinks there is blockage in an artery (front right portion of the heart) and is recommending a Caronary Angiogram as next step.  He also asked me to start taking Baby Aspirin, Toprol and Lipitor.  He has not done any blood work so far -- so I do not know what the LDL levels are.

I am a 38 year old, active, non-smoking male with reasonably active lifestyle.  I work out about twice a week (cardio and weights) and play golf every week.  I have never had any attributable chest pain or discomfort so far other than the PVCs in the past two weeks.  I did have acid reflux which was treated with medications -- eventually got off the medications by altering lifestyle and diet.  However, I felt the reflux coming back in recent weeks because of bad eating habits.

All of this has been moving too fast for me -- the doc wants to do the catheterization tomorrow !!  Based on what I read on the internet, CA is an invasive procedure and I am not ready to go thro' that unless I really have to.  Am I at a risk here if I push the procedure for another 10 days so that I can get a second opinion.  Also, do I need to start on the Toprol and Lipitor right away even before knowing the results form the blood work that was done this morning?

Any comments, suggestions and advice will be greatly appreciated.

Thanks
A

[erijon]

Sorry to hear about your problems. I'm not a Doctor, I see you were able to get this also posted on the expert forum and I'm sure you'll get good advice from the forum doctors. It sounds to me like your cardiologist has a sense of urgency about this, I don't think I would wait for a second opinion if he wants you in tomorrow, he must have a pretty reasonable expectation to want you in that soon.

I would take his advice, a cath is not risk free, but very close to it. I would not risk waiting, he has no incentive to put you through a cath for no reason.

Good luck with it,

Jon

[erijon]

That's wy I'm not a doctor I guess. That was good advice he gave on the expert forum, very interesting take. Sounds like a good option.

Good luck, I hope everything works out for you.

Jon

[kenkeith]

My experience has been to seek another opinion from a non-interventional cardiologist as an interventional cardiologist favors doing an angiogram and then almost always implants a stent or stents.  I have had an interventional cardiologist and currently non-interventional.

Usually, it is chest pain (ischemia related) uncontrolled with medication that invokes intervention.  Since learning I have a totally blocked LAD and 72% blocked ICX going on 5 years, medication has been the mode of treatment without any problems.  Intervention therapy does not increase one's mortality (google COURAGE study), and I can cite studies that indicate there are excessive stent procedures that don't warrant the intervention.  The studies are fairly recent and an outgrowth of drug eluding stents that have a restenosis tendancy.

A non-interventional CT 64 slice coronary angiogram is as good as a CA.  In addition, the CT gives a complete 3D view of the vessel anatomy and whether or not there is remodeling as well as plague buildup on the outer side of the lumen (significant because it is that plague that breaks through endothelium (lining of the vessel) and it is undisputed that this condition is the highest risk for a heart attack...not the partially blocked lumen.  Also the abdomenal (abdominal) aorta is viewed and the respiratory system including full-of-field view of the lungs mand soft tissue windows are used to evaluate extracardiac soft tissue.

I'm not advising, but I am suggesting you get a second opinion regardless of what the  forum doctor may state.  I recently had a ct scan and the procedure took about 7 minutes.  It is necessary to get the heart rate below 60 for clear images, and may not be for everyone as one is required to hold their breath for short time and with medication heart rate may not become slow enough for good images.  For more information ct 64 slice coronary angiogram.

You should be commended, and you are doing the right thing to get all the information available before making a decision.  Take care!  

[kenkeith]

Sorry, just read the doctor's opinion, and I agree...go medicine therapy.  Although there is some duplication I hope may long post provided additional information to help you!

[erijon]

kenkeith is a good resource, sounds reasonable to me! (I always find wisdom in his posts)

[ashnar]

Thank you guys so very much for the replied and support !  Your replies, along with the doctor's, certainly made things a bit clearer for me.  

In the mean time, I have already asked for my complete chart so that I can take it to a non-interventional cardiologist for a second opinion.  I did my labs yesterday and I am waiting for the results -- should be in tomorrow morning.  I am definitely leaning towards a CT scan as it is non-invasive and as kenkeith suggested might give me a bit more information regarding the surroundings of the heart (had acid reflux for a long time -- not sure if that caused any damage).  

Will post back with more once I get my chart !

Thanks
A

[ashnar]

OK...finally got my chart today and the cholesterol numbers don't look good !

Lab Results:

Total : 226 mg/dL
LDL: 165 mg/dL
HDL: 41 mg/dL
Triglycerides: 99 mg/dL

Stress Test Results:  (I have no idea what this means -- am simply typing the words as they are on the report)

Resting ECG:

The resting ECG showed Normal Sinus Rhythm; Old inferolateral MI, anterior T wave abnormality consistent with ischemia

Stress ECG:

The stress ECG showed Sinus Tachycardia; ST/T wave changes in leads aVF, II, III, V1, V2, V3, V4, V5, V6; Downsloping ST depression up to 2 mm.

Stress Study Impressions:

Abnormal exercise tolerance test die to diagnostic ST segment changes, without chest pain; Functional Class I; Normal incremental hemodynamic response to exercise; No exercise induced arterial desaturation; No significant induced arrhythmias

Profusion Summary:

Abnormal myocardial perfusion study; apical, apical wall ischemia

Any more thoughts/advice/suggestions based on this more precise information?

Thanks in advance.
A