Isn't a uniformly False Negative result on a cardiac nuclear stress test practically a death sentence?

[quintby]

Why do cardiologists keep using the Thallium or Cardiolite nuclear stress tests when the patients whose coronary arteries are all uniformly diseased are nearly impossible to distinguish from patients whose coronary arteries are all uniformly healthy?

[quintby]

And now the rest of the story...............

In December 2005 I had some tightness in my chest while driving and decided to go to the ER. I was released but only after a cardiologist had examined me and set me up for a Cardiolite nuclear stress scan.  I arrived after having sprained my ankle the night before but they said, no problem we'll use adenosine to simulate the stress. It's considered equivalent.
Having lived in the shadow of my Dad's death from an MI at age 54 and the death of all 3 of his brothers, none living past 63, I was terrified. Then a few weeks later I got a call from someone at the cardiologist' office. "Your test results were normal" she said. No, I didn't need a followup.

I was astounded and elated. Never having had any angina before, I still did take a statin and aspirin, but I felt like a huge weight had been lifted from my shoulders.

Fast-forward to January 2007 13 months later.

I awaken at 4:00AM, walk into my teen sons bedroom and tell him to get dressed. We needed to join the militia because an "alien craft' had done a touch and go on our little country road. Thinking I was sleepwalking my wife guided me back to bed. 5 hours later, I am still delusional. My wife heard a thud, then I came walking into the kitchen. "What'd you do to your eye? It's bruised right below it. It was when I could not giive her any explanaton and seemed puzzled that she loaded me into the car and drove me to the ER, mainly because of my eye. When we arrived we waited in waiting room until the triage nurse asked me questions that I answered, then yawned as she took my blood pressure. She took it again and said, your blood pressure is 69/40. What is your normal. When I said 136/85 I was quickly brought into to be examined.

I do not recall the next 19 days - all I know is what I've been told.  But to shorten a long story I was in a coma for 5 days on life support, in the ICU for a total of 17 days. I was thought originally to be in cardiogenic shock but I was not having a heart attack. My kidneys failed, my lungs, my liver, my heart I had a thorough case of Multiple Organ Dysfunction Syndrome, ARDS, SIRS  and by all accounts I was going to die. The doctors wanted to do an angiogram but they thought the test itself would kill me.  Besides, they had a copy of my SPECT nuclear stress test results. They thought it unlikely that my arteries were clogged, yet I had an ejection fraction of 20.  Finally my kidneys recovered enough that they decided to risk the angiogram.

My wife says she never saw a group of doctors look so befuddled when she met with them in a conference room and my cardiologist said, Mrs. K---- your husband needs open heart surgery. Bypass surgery. It was silent and she asked well how important is it to do now.  Couldn't it wait till he's better from all the other stuff. How many bypasses?

The surgeon said "basically all of them". It's quintuple bypass surgery he needs. Today.

Again, I was apparently conscious and conversant for much of the 19 days but I remain to this day blacked out over nearly all of it.
My primary care doctor later told me I should have died 4, maybe 5 times over. No one could explain why I hadn't. It's hard to end a strange story with harsh feelings, but had I been able to have my quintuple bypass when it should have been spotted, in 2005, as a scheduled surgery when I was not already near death from apparently unrelated reasons (sepsis), I might be able to say that I'm doing just fine. And once in a while I am.  But what my body went through, failing here there and everywhere, only to need in the middle of it all to have my heart stopped, operated upon, and shocked back to life. It's hard to explain, but my body keeps saying, It's all just too much. I have serious bran damage which slows my thoughts, exhausts me when I do even small amounts of activity and makes it hard to have a conversation without forgetting several of the words or names I want to use.  

Had I had this condition even 15 years ago I would not be alive. They did not understand MODS yet. Somewhere. my spirit seems to have eked out of me. I'm working to get some of it back but....

[quintby]

I'm sorry to hear about your condition.  Have your docs considered a test that is readily available in metropolitan areas and becoming more common. Until a few years ago CT scans were too slow to produce a readable image. Then the newest gen of high speed CT scanners, the 64 slice scanner came on the scene. Most cardiologists who work with them find their imagery to be satisfactory as a substitute for a conventional angiography.  In fact, it is  called the 'CT coronary angiography'. You don't list an angiogram among your tests, and likely have avoided them due to the risk involved?  Anyway, the CT coronary angiogram is a recognized alternative to the so-called gold standard conventional angiogram.  It's only problem is cost and naturally most health insurers classify it as medical unnecessary.  However, with your extensive history of tests and a cardiologist willing to go to bat for you, you might be able to leap past that hurdle.
Remember, I'm not talking about the CT Calcium Score test . I'm talking about what some call a virtual angiogram.  One more thing - has your cardiologist looked at other cardiac conditions that cause pain, like myocarditis?  Another one more thing - have you considered climbing down the tree of specialists and seeing an Internal Medicine specalist?  There are a fair amount of pain conditions which masquerade as angina. For example, pancreatitis, which can refer its pain all over the place   its the nature of cardiologists and all specialists is not to look past their own specialty. Wouldn't it be great if the tests were correct and that your pain source is only referring pain to your heart!

[ed34]

No test is perfect. The only way to tell the absolute condition of a heart is to remove it, dissect it and have a good look around. (any volunteers?)
The problem is, the major coronary arteries are the ones targeted nearly all the time. However, there are countless smaller vessels running through the heart tissue which can give nasty symptoms when blocking. These problems will not show on a thallium scan. If there are problems with these vessels, there is nothing that can be done anyway, they are microscopic. A thallium scan does reveal obvious blood flow problems where a large blockage exists. However, if natural bypasses called collaterals have formed, these blockages will not show up. I still think the best method available is an angiogram but this obviously has risks attached and still only shows the larger vessels. It does however reveal blockages even if collaterals have formed.
I know it can be very frustrating when tests reveal nothing. I've had ECG's galore, echo scans, stress echo scans, exercise tolerance tests, nuclear scans, lung function tests and still they cannot explain my worsening angina.

[erijon]

Hearts that have uniformly diseased arteries will not perform well under the stress portion of a nuclear stress test, which was the case with my father. The pics looked OK but he failed the exercise portion. Also, if you are still having symptoms after a normal Thallium stress test, normal protocol would be to proceed to an angiogram. Remember, a nuclear stress test has a 97% specificity meaning that 97% of patients with negative or normal results are actually negative, so someone with a normal result is pretty safe. False positives are much more common.

Jon