Nuclear Stress Test Question

[wildcat27]

Hi all,

This question comes from curiosity after reading a post on the doctor's forum by a woman whose husband had a heart attack a short time after a negative nuclear stress test. The doc responded that the test is very good for detecting blockages that are preventing blood flow, but not an indicator for possible ruptures that might occur? I might be remembering that wrong.

At any rate, what is the best course of action to take? Do people need to start getting heart caths done to make sure they don't have blockages? This seems extreme but possibly necessary...

At what age do men need to begin investigating this? And with what background.

I have no history of coronary artery disease in my family, except for one great uncle on my mom's side...my cholesterol is 170 (or I should say was 170 last spring)...I work out regularly and eat pretty healthy...I am 30 years old...what course of action do I pursue down the road.

Thanks

[va_tony]

In my opinion, catheter angiograms as a routine screening test for the general public is far too drastic (and not without it's own risks).  Better would be the non-invasive nuclear stress tests and the CT-angiograms. But even their routine use wouldn't be justified.  Also, I don't think your health insurance will pre-certify any of these tests (they are expensive) unless there are compelling reasons. I'm 64 with chronic afib and my cardiologist wanted me to have a nuclear stress test before increasing my med dosage (meds like rythmol may be dangerous when one has blockage).  He had to argue with my insurance carrier (Aetna) to get them to agree.

I would think that the appropriate tests to begin with are an ekg and an treadmill (with echo) stress test.  You can learn a lot about potential blockages from those. As I recall, my GP didn't refer me to a cardiologist to undergo routine stress testing until I was in my 40's.  Even then, I had a history of high blood pressure so it was warranted.

In any event, the odds that, at your age and family history, of having a coronary artery blockage is just about zero.  Just eat healthy, exercise and stop worrying.

[wildcat27]

thanks tony...very good advice...just wanted to hear what others thought.

hope the weather in VA is what I remember it being like in April.

God bless.

[Al Dente]

good points.  exercise stresses aren't the most exact tests (without echo or thallium/MIBI) they are not of much diagnostic value.

they aren't predictors, but can show some issues--they are less selective with smaller blockages.

young people can have heart disease (CAD) serious enough to cause problems...I think the stats are pretty low, and it is overplayed as low--however the risk of using stats to say "most likely" you are ok is dangerous.  someone has to be that "number."  if you have a significant family risk like mom or dad, brothers dying early or having early heart problems, then the alarms should go off.

i had my stent put in my RCA just about 2 years ago at 28.  i have diffuse CAD and some other heart stuff going on.  i have extreme familial heart issues on both sides, so it can happen.

caths IMO are very strong for revealing CAD & other structural issues, but they do have risks.

[va_tony]

I agree that some have CAD even in their 20's... but as I wrote, with wildcat's age AND family history (i.e., no heart problems in Mom, Dad and siblings) and the fact that his total cholesterol is 170, I'd say the odds of CAD are very low. He really shouldn't worry about it unless he has symptoms.

[Al Dente]

agree tony, i don't think people should be staying up at night worrying about heart issues--especially if a person has no symptoms....if you're symptom free enjoy life!