My husband was advised to have a heart cath based on ECG findings. He is 71 yo, non smoker, n/l cholesterol, triglycerides, blood pressure is normal. No family history of heart disease. Heavy drinker 3-4 days week.
The way to look at it is that the Cardiologist wouldn't suggest a Cath unless he felt it absolutely necessary, he is fully aware of any potential risks. He must feel that there is a problem posing a higher risk than the Cath if not investigated and hopefully dealt with. Problems with Cath procedures are very rare, so I wouldn't let this deter me from having a possible heart attack prevented. I really have lost count how many Cath's I've had now, and I'm still here. If I hadn't had them, I probably wouldn't be. If you have any questions at all about the procedure, please don't hesitate to ask. There is no pain involved and the procedure is over with in less than an hour in nearly all cases.
We have also seen on ABC News about all the unnecessary heart caths being done in Florida. We live in Jacksonville, so that contributes to the hesitation when there is nothing in lab work or echo to suggest CAD. Is it possible the ECG finding was an anomaly? We will be seeking a second opinion. We do not know the cardiologist findings (I didn't go with him to the doctor :-/) We will have that information on Monday. :-) Thank you for your input,
There is always a chance they will find nothing during a cath, but that procedure rules out many issues. I don't take much notice of the media, and I'm sure that all those Cath procedures had no issues. Whatever Cardiologists decide or do, there is always a report which is contrary. Cath procedures are the gold standard for finding any heart disease.
I remember when I was having chest pains about 3 years back. ECG/Echo all returned normal. My cardiologist recommended a cath which I agreed to. It looked clear. However, they used a special device on the tip of the catheter and discovered a huge disruption to blood flow in a major artery, but it was invisible to the eye. 2 stents later it was back to normal and I felt great. These are the stories you never hear in the media or see on the internet :(
I can tell you a sample of 500 patients from 2007 have been researched recently in the UK. Half had only the vessel causing a heart attack stented, other blockages were left. The other 250 patients had all blockages 70% and over treated. The results conclusively revealed that stenting all blockages reduced further attacks or death by 64%.
Update... We have followed up with the Cardiologist that did my husband stress test that should the abnormality. He now state that they will do more blood work (CRP, homocystine, LpA, expanded, lipids); if that shows any thing ...he will a nuclear stress test. He also has a scheduled appointment with another Cardiologist for a second opinion.
Personally I think that's the wrong way round, but that's through personal experience. I received my first stent in 2007 to stop a heart attack, and it was seen during the angio procedure that my left artery was totally blocked. They could see some blood was going into it from somewhere, near the bottom, but this was invisible. They had a hunch that some of my heart muscle would be dead so I was put in for a nuclear scan. The nuclear scan revealed my heart like that of an athlete, but I felt awful. The cardiologist said "If we had done the nuclear scan first, I would have dismissed you having a healthy heart. However, we know this to be wrong". This happens in quite a number of cases because collateral vessels give feeds to areas not getting enough oxygen. They give the same amount of blood if the heart is as rest OR if stressed, so is very misleading.
Maybe it would be of use if I explain what the nuclear scan is. They inject the patient with a radioactive isotope which attaches to the red blood cells. This is great because on the scan it shows everywhere that oxygen is reaching, but they obviously only scan the heart.
They then put the patient on a treadmill and get their heart rate to the desired level. If the patient can't reach that level through fatigue or discomfort, they resort to an injection which stresses the heart. If you have heart disease, it suddenly feels like someone is sitting on your chest and breathing is very hard. This lasts for about 2 mins tops. They then take the patient to the scan room where they have to lay on their back, keeping still, for about 30 mins. Slowly you watch the machine go around the front of the chest as it takes images. They then send you away for about 2 hours and ask you to eat a fatty meal. When you return they administer a high dose of Nitrate to force the vessels fully open. This sudden drop in blood pressure causes many patients to get a thumping headache for about an hour. They now do a second scan for about 30 minutes.
The first scan was with the heart stressed, requiring more oxygen, the second was with the heart relaxed. The two sets of images are looked at by an analyst and looks to see if oxygen supply is less in the stress scan compared to the relaxed scan.
1. If the stress scan shows no increase in oxygen levels, then disease is likely and what they term reversible.
2. If both scans are dark in an area, the muscle has died and is irreversible.
3. If the scans show no difference in an area it can be interpreted also as a normal supply, but could be a blockage.
In the UK this scan is used more now to backup Angiograms if something isn't obvious after the procedure.
If fear is the main reason for holding back with the angiogram, why don't you ask for a ct-angio which is non invasive, and will give a calcium score. This will indicate if there is plaque in the arteries and how much. However, whatever scan you have, if they reveal heart disease of a substantial level, it will always lead back to the original option, an Angiogram.
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