Re: Is my heart really OK?

Posted By Linda on July 22, 1999 at 09:25:24
I am a 49 year old female about 20 pounds overweight, cholesterol of 237 (but with a good ratio), very low blood pressure, no history of tobacco use, and a good family history (heart disease on both sides but after the age of 60).  For the past six months I have been having chest pains (a squeezing sensation really) and fatigue.  Because I have no risk factors, my PCP reluctantly ordered a stress test. It showed some abnormalities in "slope".  From that we went to a thallium stress test.  I had both parts (exercise, then rest)and the diagnosis was that I had "inferior wall ischemia".
On Monday I had a heart catherization.  Both my cardiologist and I were surprised that everything was normal.  He ordered gall bladder tests and they discovered I have a minor problem with my gall bladder and will someday need to have it removed.  The general consensus is that my gall bladder has caused the chest pain (which I still have).
My question is - is the heart cath reliable?  How could all three stress tests indicate ischemia and the left heart cath say "no problem".  Should I get my records and seek another opinion from a cardiologist?  Should I do any follow-up over the next few years?  If so, what?

[CCF CARDIO MD DLB]

Posted By CCF CARDIO MD - DLB on July 22, 1999 at 11:12:51
Dear Linda
The results of the heart catheterization are very reliable. If there was no blockage, then the stress test results were wrong; this happens sometimes with stress tests, especially in people that are overweight. You should follow-up regularly with your primary care doctor. You should also think about losing weight and lowering your cholesterol before these risk factors actually lead to heart disease.
A murmur that changes with position (and disappears) as in your daughter's case is usually due to a benign or innocent murmur. These tend to go away with increasing age.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

[Lori__0__0]

Posted By Lori on July 23, 1999 at 13:44:51
I had a situation similar to Linda's except I have no gall bladder problems, I do have high blood pressure and my cholesterol is very low (115 overall 70 LDL/45 HDL).  I had a highly abnormal stress test and I was experiencing crushing chest pain, nausea, pain in my back, down the left arm, difficulty breathing etc.  The only thing I did not do was sweat.  The Cardio gave me Imdur to take until I had the cardiac cath.  The Imdur (I believe because I didn't have this symptom until I took the Imdur) caused me to have searing, burning pain in my arms and legs.  When I let my arms hang down by my sides, the pain was excrutiating and only abated slightly when I raised my arms and held them straightout, waist level.  My legs were on fire and felt worse when I stood on them.  Walking was not possible.  When I stopped taking the Imdur, these symptoms abated.  
My question relates to the reliability of cardiac catherterization for women.  I have read several recent studies by such renowed institutions as the Mayo Clinic and others reported in such publications as The Harvard Heart Letter
that state there is increasing evidence that the process of heart disease in women (especially women under 50) is substantially different than in men.  One key point is that younger women usually do have clear coronary arteries upon angiography (the "gold standard" for men) yet they are still having heart attacks and these heart attacks are usually fatal because the underlying heart disease goes undetected or misdiagnosed and treatment, if any, is begun too late.  Do you have any knowledge of this information or has your clinic done any research in this area that you can share with the women who frequent this board?
Linda's concern regarding undetected, misdiagnosed heart disease/problems is genuine.

[CCF CARDIO MD DLB]

Posted By CCF CARDIO MD - DLB on July 23, 1999 at 18:11:46
Dear Lori
There is some accuracy to what you have written, though also some misinterpretation of the data. It is true that certain types of stress testing (the type without concomitant imaging) are less accurate in women than men. There are also differences in certain aspects of heart disease in women and men, also depending on age, that impact upon outcome. Cardiac catheterization, however, is just as accurate at detecting coronary artery blockages in women as it is in men. Regarding heart attacks with "clear coronary arteries," this happens in both men and women. That is because about half of heart attacks occur without severe blockages being present on cardiac catheterization. Research we have done using intravascular ultrasound has shown that many arteries classified as 'clear' in fact have signs of atherosclerosis. This has been observed in both male and female patients. However, while these milder degrees of blockage can cause heart attacks, they should not cause anginal chest pain.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

[Linda__0__0]

Posted By Linda on July 27, 1999 at 17:43:10
Thank you both for your information.  This has helped clarify the situation for me.  I do have another question though.  My cholestoral reading is 237.  I asked my PCP if this wasn't a bit high.  His answer was not to worry about it since my "ratio" is good.  How do ratios affect whether or not a reading is good or bad? Do I really need to "not worry"?
Thanks.










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