Alternate Tests

[CADGirl]

I had a stress test performed with perfusion (Myoview) because of some left side chest discomfort during times of emotion stress.  The actual stress test went well.  The Dr. said that both the rest and stress perfusion test showed some reduced flow in one area. Because of the area of concern, he said a false positive was possible due to breast attenuation. He wants to do a heart cath now.

Because I know someone that died as the result of a heart cath, one that hemmoraged badly, and have some risk factors myself with respect to a heart cath, I want to exhaust absolutely all other test options.  I will not give from this position.

What are my options?  Would a PET scan be a good alternative? My insurance will pay for a PET scan and I've heard that they are superior to the Myoview perfusion study.

Thanks

[Cleveland Clinic]

CADgirl,

PET scans may be more sensitive. Unfortunately there are no perfect test. Each test has the ability to give both false positives and false negatives. Alot of the interpretation and suggestion for the next steps in testing would depend on my examination of you and your overall likelyhood of having coronary disease. For example, if your likelhood was low and the findings were very consistant with artifact and there were no high risk findings on your stress test, I probably wouldnt order any other test.  If your likelyhood was high, I might skip stress testing all together and proceed to catheterization as the likelyhood of a false negative might be high.  

Remember the more test you order, the more likely you might have a false positive or a false negative.  

Maybe a second opinion would help ease the next step of care before proceeding.

good luck

[DottyCece]

What are your risk factors in regard to a heart cath?  Usually, it has to do with the dye such as allergy or in the case of renal insufficiency, it can cause worsening of renal problems.  Though hemorrhage is a complication, it rarely occurs in a heart cath.  There are a number of products available today that will seal the arterial puncture site and will prevent bleeding etc.  I have had two caths in less than a year and both went very well.  With the new products they use, bedrest is significantly reduced.  However, I understand your fears.  But in the scheme of things, a heart cath has a very low risk especially if you have it done at a place where they do lots of them and you have it done by a very skilled interventional cardiologist.

[CADGirl]

Low risk is a matter of perspective. If you have a friend that died as I did, then your perspective would probably change greatly.

If you look at the mortality and morbility rates, a heart cath is really realatively risky. Here are a few numbers to think about.  You are 12.5 times more likely to die from a heart cath that from being in an auto accident.  100 times more likely than a gall bladder removal, 93x a liposuction, 33x natural childbirth, 6.5x a C Section, 13x skydiving (200x a single jump) and 10,000x an international flight.

As far as serious complications go, the odds are the same as having fraternal twins - I have a set of fraternal twins.

I just believe that anyone would be foolish to expose themselves to the risks before all other alternatives were exhausted.

[bama jane]

Scripps Clinic (in San Diego) their Integrative Medicine Dept either has now or will soon have the latest technology in the Super fast CT pet scans. I saw a presentation of what this can dectect and was really impressed.  I have heard cath's are supposedly the gold standard, but as I understand it this will eventually eliminate the need for them unless they find you have a blockage. All they do is insert some dye through an iv in your arm and it looks like a virtual reality tour through you arteries for the doctor. I really was amazed.  It is done with your clothes on.  I know a lot of people from all over the country go there for their healing hearts program, I was in it and met people from other places. I think opinions differ on this scan depending on the doctor,but if it is a possibility for you to do that it is at least another option that isn't as invasive. I am by no means an expert on this just wanted you to have that information. Cleveland Clinic may have the same thing, I don't know.  Good luck!

[Dr. Erik]

Well, would you like to get the Heart Cath done with a 0.5 percent risk of complications or live with a 30 percent risk of dying from an MI. In this case I think your doctor feels the benefits outweigh the risks. Best of luck to you!

Erik

[CADGirl]

First, I am gathering this information in preparation for a second opinion.  After my Stress and Perfusion tests, I found out that my current Cardiologist had been terminated from several practices in the area and that my tests we improperly (grossly) performed.  

Now, the point is neither risk is acceptable if there is an alternative.  If PET scanning (or other test) will provide sufficient accuracy to avoid a risky invasive procedure, which many say it does, then that is the best of both worlds.  

Pardon my cynicism, but a lot of cardiologist, including mine (old and new), have their own cath labs.  They have a vested interest in using it.  I don’t want that clouding his judgment, intentionally or not.  At some point a heart cath may only be a “gold standard” because it is more profitable for them.  Not too long ago, exploratory surgery was the “gold standard”.  Many were slow to accept the alternatives.  Are we at or close to that juncture with respect to cardiac testing?

I want a cardiologist that will work with me and (I’ll say it again) exhaust all low risk non invasive alternatives.  I am the patient, AKA Customer, and I don’t think it is unreasonable for the doctor to work with me.  In the end if a heart cath is necessary, then so be it.  But, I will not be rushed into it.

[Dr. Erik]

Well, I hope that the test was a false positive and that your arteries are clear.I understand you reservations for having a heart Cath. As long as you're feeling well at the present time, it shouldn't hurt to wait for your second opinion. Good Luck.


Erik

[CADGirl]

For anyone reading this far down in the forum:

I got a second opinion from the best cardiac practice in the area. They determined that I had upper GI tract irritation from Vioxx.  It was also contributing to high BP.  They did do a doppler echocardiogram with no problems found.

2 days after discontinuing Vioxx, I became symptom free, my BP is back to normal, and I have been fine since.

Bottom line: always seek out the best doctor and always get a second opinion before undergoing any invasive or risky proceedures.

[ParkerP]

Good for you! I was under the impression that "doctor knows best" until my dad had an ablation by cath which resulted in a stroke during the procedure. He was having it done for a non-life threatening problem that could have been fixed with beta blockers, and is now unable to work ever again. You are totally in the right.