Results of Stress Echo scan

Well, my ECG looks great, my standard echo shows no problems, my LAD is supposedly still very patent, LCx has no disease, RCA has some disease and blockages but there is sufficient cross flow, lung function test above average, Nuclear scan shows fantastic flow to all tissue areas, Stress echo (although produced high chest pains and throat discomfort) show excellent functionality.
Cardiologists have written to GP saying they strongly recommend no more investigation with angiograms.

So, I'm at a loss. I assume that if I want to see if my LAD has problems associated with the recent stenting, a CT scan will show these? I get the impression the cardiologists think it's all in my head and there is no angina.

Is there anything that is better at showing perfusion? I've had 2 nuclear scans but they show excellent tissue reception. I know my heart is short of oxyen somewhere, but how do you pinpoint it?

[joanincarolina]

No tests are going to show down to the microvessels.Even an MRI of heart without and then with medication will show no wall abnormality. These tee-tiny vessels are massive web in the heart muscle. Angina from these smaller vessels are subjective, not proven by technology.It is not in your head.Did you discuss this MVD with the doctor? It would take alot of either infarct in these vessels or spasms before damage would be done. You just have to be clear about when the angina is from the larger coronaries or the smaller vessels. Joan.

[kenkeith]

Question: "So, I'm at a loss. I assume that if I want to see if my LAD has problems associated with the recent stenting, a CT scan will show these?"

>>>My CT angio report in regard to the stented RCA states, "cannot visualize inside the stent but there is good flow present prior to and just beyond."  The conclusion would be obvious.

[ed34]

"Did you discuss this MVD with the doctor?"

Not yet. I am still waiting for my GP to respond to the hospital letter and put me on Nitro patches to see what effect they have. In a way, Im hoping they do something beneficial to prove Im not going nuts and there is ischaemia.

[joanincarolina]

Thank you. It's nice to know you're not ignoring me on this subject.:) Joan.

[LindaTX]

Hi ed, sounds like you are doing well.  My Dr in Austin wants me to go ahead with an ablation in a couple of weeks.  My doctor, Cardiologist, here wants me to have an echo, I know what that entails  and something called a Thallium- Dipy...?  While you are on here could you maybe tell me what that is.  Is it a kind of stress test that might throw me into a-fib or some other arrythmia?  The word stress when linked to a test freaks me out..

[ed34]

Hi Linda, a Thallium scan involves having a dye injected into your circulatory system when you are exercising on a treadmill. If unable to do this, your heart rate will be increased using medication. Stress is a strange word really I think, it simply refers to your heart working harder, at the optimum for your age etc. Hardly stress in the sense of the word is it. Anyway, you have one scan with the heart having been stressed and they take 20-30 mins lying still. Second scan is about an hour later with the heart being relaxed and this is another 20-30 mins. No pain, no problems.
Personally I find the chemically induced stress quite nasty, I just don't think my body likes those chemicals. I much prefer the treadmill method.
The radioactive substance flows through your arteries and eventually finds its way into your heart tissue. This gives a nice glow on the scan images, showing oxygen is getting to all heart tissue/ or not. It's a good test to see if any areas need attention due to a blocked artery. I have had 2 of these tests and had no side effects. If you take beta blockers, I think you have to stop them for a while before the scans, something like 1 or 2 days.

[LindaTX]

Thanks so much for the reply, ed.  Sorry for the interruption on your thread.  I know you three are among the most knowledgable on here.  I'm feeling pretty desperate because I'm set up for an ablation with one of the best Dr's in the world.  My regular EP, who is now in practice with this renowned Dr. has been pushing ablation for the last few yrs. So, what's the problem?  Everything in me says this isn't the answer to "my" problem.  I do have a history of a probable MI in my inferior wall way back, which may or may not mean anything, just showed up on an EKG.  After your explanation, I'm pretty sure that's what happened to me when I had a stress test a yr and a half ago in Alaska.  I couldn't finish the treadmill because of SOB, so they gave me a med to race my heart. I don't think I had the contrast. They had me sit for about 30 min because the med had thrown me into a-fib.  Then they put me through the ?scanner and I went into v-tach so they never completely finished the test, just admitted me to the hospital for a few days and changed my arrythmia med because evidently if you have any underlying heart issue, you can't be on certain medications for arrythmias.  Fast forward to yesterday.  Went to a Cardiologist, new to me, and when he found out I had a rhythm problem he didn't want to see me, told me I should go to an EP.  The head of the dept intervened, saw me, and set me up for the echo and thallium test.  So I have that tomorrow.  Well, last night during sleep I went into a-fib, which will probably last all day today.  I feel like there is a build-up somewhere in my heart that precludes these almost weekly episodes. I'm not so sure burning my heart is going to address the real issue.  What do you all think?

[ed34]

Ablation is a way to try and stop arrythmia problems because they basically destroy the cells interfering with the signal going to each of the chambers. Once the problematic area has been isolated and dealt with, your heart should be able to stay in the correct rhythm.
I was offered this treatment 2 years ago, but for different reasons. They suggested that I have cells killed which are causing the feelings of angina. The reason I refused is that how can  I ever tell if I have a heart problem if I feel nothing. I need the discomfort, it tells me there's something not right, and if the discomforts worsen, I know my heart is getting worse. Also, if I exert myself too much, how do I know if I am causing irreversible damage to the tissue if I feel no symptoms. If they can't find my reason for angina, I fail to see how they know which cells to destroy. In the end my Cardiologist agreed with my reasoning.
With regards to your thallium scan, I know you are worried about a-fib or v-fib but there are always cardiologists at hand.