Heart CAth

[briane]

I have had chest pains and some times tightness in my chest for about 1 and a half years.  a little overa year ago i had a stress test with scans which was fine.  Going on a year a go I had a holter monitor and an ultra sound of my heart.  All that showed up were PVC's and Pac"s which I was told were benign.  Finally friday I had a left heart cath and was told afterword my heart was clean as a whistle and thats all ( and that was as he walked past).  I to follow up with my primary care physician on the cause of the pain.  I have no appointment with the cardiologist to explain anything.  My questions are is a left heart cath standard?  INstead of the whole heart or a right heart cath?  Is a left heart cath sufficient to put my mind at ease when I have this pain that it isn't my heart?  Along with the other testing of course.  Could you explain why just a left heart cath might be done?  I am a 37 year od female with a strong family history of heart disease.  My symptoms changed over time some and the pain is not always in one spot.  The tightness just showed up the last few months.  Thank you for your help.

[CCF-M.D.-CRC]

Dear briane,
When most doctors say "heart cath" they are referring to a left heart cath which is injection of the coronary arteries.  A right heart cath is not "standard" in the evaluation of chest pain and is used only in special cases.  A left heart cath by itself is the "gold standard" for making the diagnosis of chest pain due to coronary artery disease.

[briane]

I guess what I'm mainly trying to find out is if once you have had a left heart cath can you be pretty sure your heart is not the cause of your symptoms? My symptoms are pain, cramps and tightening.  Are cardiac cath's 100%?

[itsa48]

hi i read your post...just myself had a heart cath. and got the bill and it even said left heart cath.  but they do check the whole heart!  i have coronary artery spasm which happens to be on my right side of my heart.
so rest easy!  they checked your whole heart.
Lynn

[pikamom]

Hi Lynn. You and I had our test around the same time and I didn't get my bill yet. I never even asked which side of the heart they were looking at, didn't know you had a left and right heart. The only think I know about hearts is what I learned on this site, things like PVC's are usually benign. When I went to my follow up with the cardiologist he tried to explain about my angina and where my tachycardia was originating from (ventricles and atriums and stuff??)...I got the part about me not dropping dead from my condition. I also got the part that even though I'm not going to be hurt today from the tachycardia/angina, my heart could get weak eventually, so I take my cardizem every morning. Now I don't know if he meant my whole heart, or the right or left side. Oh, my uncle was just in the hospital for heart failure, I'll have to ask my mom if it was right or left heart failure. That should impress her. I'll tell her I'm getting an education on the internet!

[itsa48]

terry,
don't have heart failure when you get your bill, just the heart cath was 6400.00 that didn't include the dr. the person that reads it the hospital and the list goes on...i had one drug they gave me 9 times at 320.00 a pop.  so far my hospital bill was over 18,000 waiting on dr. bills and radiology etc. my room was 552.00 per day...oh and the ambulance another 500.00
but i thank god every day all these people where there for me.
i have done good no spasms since sunday...i know it does not sound like alot but........it is i count each day now.

Yeah my dr. told me about the right side and the left side that is how i knew mine was on the right side of my heart.  but he did test both sides i do remember him telling me that too...its called a ergotivine challenge test.  that is how they found the cororary artery spasm. and i think i told you they also found some blockage in that same artery...Maybe just the artery's are on the right and left who knows, they did some other things to, hubby said i was in there for about hour and 1/2.  didn't seem that long to me, but i'm sure it did to him. that was on a friday i didn't get to come home till that monday, i think i told you because i had blood pressure problems (to low) and terrible nitro headaches. glad your meds are working, after a 5 weeks mine finally are too!

[cge]

Just because you cardiologist says your arteries are fine it doesn't mean that there isn't another problem with your heart.  It just means exactly what it says, its not your arteries.  

The oxygen sat, anything below 95% is abnormal but your report doesn't put figures for that.  If you have 96.5, obviously something is causing that.  It could be valves, stenosis and I don't know what else.  

So please do remember, if a physician orders a cath for blocked arteries, that is what is going to be reported.

Untreatable conditions are not always diagnosed.

[pikamom]

Yeah, clear arteries doesn't mean your necessarily clear of a heart problem. My arteries are normal, but I have an "electrical" problem that needs treatment. Makes me think I've got wiring through my body like a house and there's a short circuit somewhere.

[briane]

What concerns me is  If your a person like me with ongoing undiagnosed chest pain just what does it take to rule out it being your heart if a heart cath does not do it.  This has been a problem with me for about a year and a half.  As I said in my first post about a year a go I had a stress test with scans and was told it was fine and sent on my way.  Last june I went back to the cardiologist on my own and they did a holter monitor and an ultra sound of my heart.  All that was found was PVCS and PACs which I was told was benign.  All this time I continue to have chest pains ranging from aching to cramping and tightening.  Sometimes I get clammy or nauseas with it although I have no idea if being scared causes me to do that.  Finally my doctor sent me to a cardiologist to see about having a heart cath done.  He put me on 5 mg. of norvasc for 2 weeks to see if maybe it was prinzmetals angina.  When that didn't work he took me off the norvasc and scheduled a left heart cath.  I was told in the hospital just after coming out that my heart was clean as a whistle and sent on my way again.  I'm supposed to follow up with my promary care physician.  I still have the pain and will go back to my physician, but was wondering if anybody has any suggestions or input.  Is there anything I haven't ruled out heart wise with the tests?  What is it and how do you rule it out?  Other options are being looked into as a cause of the pain, but no diagnosis yet.  Since its in my chest it continues to worry me about my heart.  Any comments would be greatly appreciated.  Thanks and God Bless.

[pikamom]

I'm not a doctor, just a patient, so all I can offer is my own experience. When I started having problems one year ago I had EKG changes of 1.5 mm ST depression and tachycardia. My holter was abnormal so I had an echo and thallium stress test (both normal except for PVC's and trace valve insufficiency). My family doctor felt I had a cardiac problem as opposed to panic attacks so he packed me off to a cardiologist. I was given nitro and it always worked when I got the chest pain. What I can gather is that if you've had a normal EKG, stress test, echo, holter, and cath...then you probably don't have a cardiac problem. In my case my heart structures are normal (chambers, valves and arteries) but I have an electrical problem causing tachycardia, and with my high heart rates I get the EKG changes showing the heart doesn't get enough oxygen. You can probably stop worrying if your heart itself is normal and you don't have a rhythm problem. Lot's of other things can cause chest pain, I'm sure you've seen the cut and paste list doctor's response to many of these questions. Since the most worrysome is heart, get that ruled out first and then go from there. When all else is ruled out then you will probably be referred to a psychiatrist. That's not bad, I've been going to one for a couple of years. Even my psychiatrist wasn't convinced my cardiac symptoms were panic even though I wanted to believe that. I can tell you aren't convinced that you don't have something wrong with your heart. In that case it can't hurt to have an appointment with your cardiologist and tell him of your fears. Have you used a holter or some other recorder so that your rhythm can be captured during your symptoms? That would be really reassuring. When I used the holter I was given a book to write in, and I was told my EKG changes happened at the same time as my symptoms. So if you have symptoms but nothing shows up on the EKG, then that can help put your fears to rest. I hope you get some peace of mind soon!

[briane]

Thank you for your comment. I've had an ekg, ultrasound, stress test with scans, holter monitor and a heart cath all within the last year and a half.  The heart cath just recently.  When I wore the holter for 24 hours I didn't have any bad symptoms.  I also wrote down what I had and handed in with the monitor.  I have never seen these reports, but all I have been told is that they found PAC'S and PVC's which are benign.  I can go for days without being aware of my heart rate at all and then I'll have a couple of days when it seems like my heart will skip and flutter constantly all day long.  Does that constitute a rythym problem?    I've had a couple of ekg's over the last year and a half and as far as I know they were fine. I've also noticed sometimes my pulse will be in the 50's and sometimes 80's or 90's regardless of what i'm doing.  Thanks agoin for your comments.

[pikamom]

Some people get treatment for their benign PVC's if the palpitations are particularly upsetting. There are medicines or even that proceedure called ablation where they go in and "burn" the area of the heart that's misfiring. Ask your doctor about it. Maybe your could wear one of those montitors that stays with you for a month and you push a button when you're having the palpitations. That way you'd have a better chance of recording it than with Holter. Try to avoid things that increace the PVC's like caffiene, cough/cold medicines, "natural" supplements that contain ma huang (ephedrine). Make sure you get lots of exercize and water each day, get enough sleep and eat a healthy diet/maintain a normal weight, and eliminate stress. Prayer/meditation can help.

[itsa48]

What concerns me is If your a person like me with ongoing
undiagnosed chest pain just what does it take to rule out it being your heart if a heart cath does not do it.

I feel for you the not knowing is the worse part...i was quite upset when i was told that i had coronary artery spasms, but was relived that finally after my other nutty dr....had me thinking i was nuts!  that they finally figured out what it was.  

now in your case, i to go along with terry and if they have done the cath! then your heart is fine.  however, what about stomach problems, acid reflux do you have heartburn....maybe you have an ulcer, gallstones, maybe you should see an internest? he could get all your heart tests and see what is the next step for you.  I don't necessary agree with the phycologist part, because how is that going to solve your pain.  

I do agree with the 30 day event monitor instead of the 24 hour holter monitor but again a good internest could also recommend that test be done.  
good luck to you and keep us posted on what you find out.

[briane]

Thank you all for your suggestions.  I greatly appreciate them.  I had already been debating wheter to switch from my primary care physician to an internist.  I have been hearing an internist is the kind of Doctor to have in a situation like this.  I'm giing to make an appointment with one of them..  Thanks again.