Cath test vs heart scan

[Mommydee]

I'm a 43 yr old woman with a history of exercise related chest pain for the last year or so, I also tend to have sinus tachycardia and a low exercise tolerance due to heart rate maxing out quickly.  I have had PVCs for many years, but don't get them much any more.  I've had a history of pericarditis and pleurosy but haven't had problems with that for many years either.  I am asthmatic, take synthroid for hypothyroid (blood levels stable now), and have an undifferentiated connective tissue disease with high ANA and lupus like symptoms but scleroderma like antibody pattern (thus not specified).  My father died after a massive heart attack at age 45.  Heart disease runs in his family and my mother's family.  Although everybody else in my family requires high blood pressure medicine, I've been the lucky one, mine is usually low (occasionally it has been elevated for no apparent reason, but it always goes back down to its normal low within days).  My cholesteral ratio is great, my total cholesteral is only 144 -0 155, my bad cholesteral is low, my good cholesteral is high, triglycerides are low.  I am not diabetic.  I do not smoke, and have only rarely smoked throughout my life.  Besides the family history, I am about 50 pounds overweight, have a difficult time getting regular exercise due to asthma and joint pain, have a very high stress life, and have a high homocysteine level.  About 14 months ago I had a normal cardiolite exercise stress test which reproduced PVCs but nothing else, and an echo that indicated mild atrial enlargement due to mild mitral regurgitation, also trace or mild regurgitation from other valves; I was told this was within normal limits, that most people have mild regurgitation, and the diagnosis of mitral valve prolapse I got in the 80s following an echo was probably not accurate since the technology today is better.  EKGs throughout that indicated sinus tachycardia and PVCs according to the computer printout (docs just tell you they are fine).  I had an EKG recently prior to PT and the computer printout (Repeated 3 times on the same machine) said "consider anterior wall infarction" "possible AV node block" and "idioventricular rhythm" and "possible atrial fibrillation."  I went back to cardiologist and he looked at the new strip and said he didn't see anything too bad and in light of normal tests one year ago he didn't see any reason to repeat any tests; they did NOT repeat the EKG because they said insurance wouldn't pay to have it done again.  However, when he looked down and realized my dad died at such a young age he said although he felt the chest pain was related to the connective tissue disease and fibromyagia, to be sure they might need to do a cardiac cathertization, but he hated to do that on a young woman.  So as a test he started me on IMDUR ER ( an extended release form on nitroglycerin ) to be taken daily and also NITROQUICK SL ( the short acting sublingual form of nitr ) to be used when chest pain occurs.  If these drugs help then he will consider the cath.
The drugs do seem to help, I have had less chest pain since taking them.  Because I have had the flu and a severe flare up of the connective tissue disease, I have not had as much exercise as I usually get, and I only really get the pain with exercise, so the "test" might not be as accurate at this point since I haven't been able to do my normal activities.  However, at first even things like stair climbing or doing laundry at the laundrymat would bring pain, which the nitroquick helped, now that I've been on the Imdur longer most of the time I don't need the sublingual form.  Also, I have Reynaulds Phenomenon and my feet nor fingers have been turning blue since using the nitroglycerin.  I am scared he will want to do the cath test since there is some improvement.
Here are my questions:
1.  Would one of those new ultra fast CT heart scans I've been reading about be appropriate to rule out the need for a catheterization?  I have read that especially in young woman, they can be used as a noninvasive way to virtually eliminate unnecessary caths.
2.  Is it possible that the nitroglycerin is responsible for improving the Reynauld's phenomenon or is that likely to be just a coincidence?
3.  Since the chest pain has been reduced so much with the nitro, and the only side effect has been a lowering of my blood pressure that has not bothered me, why not just keep using the medicine and forego further tests unless more symptoms occur?
4.  How does elevated homocysteine levels fit into the risk assessment?  Are they more/less important than cholesteral ratios (I have read both viewpoints depending on which camp is talking)?
Thank you very much for taking your time to answer these questions.  I am sorry it is long, but I have tried to post for several months, so I wanted it to be thorough.  This is a great service and I really appreciate it.
Dee

[CCF CARDIO MD - DLB]

1. No, I think the test may only add more conlicting data to your case.
2. It is very likely that the nitro really is helping the Raynaud's
3. This would be one approach, though I never favor treatment without a diagnosis. Either your chest pains are from your coronary arteries or they are not - it is better to decide one way or the other and treat with medications only if appropriate.
4. Overall, cholesterol is a more important risk factor. In someone with coronary artery disease at a young age, I would check the homocysteine. In your case, I do not think it will help in deciding whether you have coronary artery disease. A chemical stress test such as a dobutamine echo would help guage the probability of your having coronary artery disease, though if you and/or your doctor are not going to be convinced by the results, a cardiac catheterization should answer the question definitively, albeit with the slightly increased risk of an invasive procedure.

[Mommydee]

I see I messed up the numbers; cholesteral levels are 144 to 155!

[christine m. smith]

Hi Dee:

I am also on Imdur and sl nitrotabs for exertional angina (although mine is in my throat/neck/jaw)  and have had a similar experience as you have. The imdur is working so well (although not 100%) that I no longer need the nitrotabs. The cardiologist I saw wanted to leave it at that and use the medication as long as it helped as much as it does. I had a nuclear scan that indicated that there is a possible blockage in the left anterior descending artery. I agree with the doctor that answered your post. I want to know if I have coronary artery disease and how much and then treat according to that information. The cardiologist has agreed to do a cath to find out. I hear that they are not so bad-you've probably been through worse already. Good luck.

CHris S.

[john m]

DEE
I know what it's like not to really know whats going on,
but at the same time having these REAL symtoms.I also have
chest pain as you mentioned for years.My echo also showed mild
L.artial enlargment,with slight mitral regurgitation (not enough
for prolapse)had ALL heart tests,except the cath. Did the nitro
thing,which seemed to help.I'm 37,and the stress of just not
really knowing was terrible,I'd get pain,I'd take nitro,over and
over.I thought,if i have to live like this fine,but what if these
pains were not heart related.THAT WAS IT,i decided to go through
with the cath.Turned out,Clear arteries.ALL these years thinking
different,these were fibro or costo pains (sometimes severe).
funny thing my toes/fingers have same symtoms.
If you do decide to do the cath.make sure you have a good cardioligist,don't be afraid to ask questions(how many have you done)mine went well,not as bad as i thought,but groin area was
sore a couple of days.I WISH YOU THE BEST!

[emma]

hi dee, i'm 47 and i've had 8 caths (long story).  the anticiption isn't fun, but when you're on the table, it really isn't bad.  i think the worst of the pain for me has been being set up with an iv, although, there can be some pain at the site where the catheter enters too - not usually very bad though.  i find it interesting even, and i'm sure i'm not alone.  i finally faced a cath without any nervousness the last time, and I went to work the next day, no problem.  i know what the fear is like though, and i truly sympathize. it really sounds like it would be better to know just what is going on - especially with the family history. best of luck!

[PJ]

If you decide to have a heart cath done, please be sure and thoroughly check out the doctor who will be performing it, as well as the radiologic technician they will be using.  Unfortunately, my husband and I never did, and when they went to inject the contrast medium they injected air instead (the rad tech "forgot" to bleed the line before connecting it).  My husband was dead within seconds.

I am telling you this not to scare you off from having the procedure, but rather to tell you to be sure and ask the questions (how many have you done, have you ever had any "mistakes" happen during the procedure, how long have you worked with the rad. tech, etc.).  Because we never did, I am now left alone with a 7 year old daughter who has no daddy.

I wish you the best of luck!

[Jim A.]

Hi Dee,
   Had A Heart cath. two days ago not bad at all some bruising at entry site. Glad i had it done found three blockages and am having surgery in five days to repair them, i am sure i would have had a heart attack soon. but early detection might have just saved my life at least it prevented any damage aheart attack would have caused. i am so glad i had the heart cath. now if i can just get through the surgery. hope in some way this note has been some help to you. if you or anyone reading this would care to iwould appreciate prayers for my up coming surgery.  Thank you, Jim Arnold

[dh]

Jim,
I said a prayer for you.  I hope the surgery goes great and that you have a fine recovery. Best wishes to you.