Should I have Heart Cath done?

[bengal lady]

Negative nuclear stress test 6 months ago, 0 cardiac CT score (without the dye), HDL 92 but Cholesterol 230.  I am 53, female, quit smoking a few days ago.  Blood pressure varies, still trying to find a medicine that I can tolerate.  My question is, I am still having upper back pressure that goes to the left side of my neck and my left arm.  It is not positional and stress/emotions make it worse.  This episode is what sent me to the hospital 6 months ago.  I stayed overnight, troponins clear and then they did the nuclear scan.  Should I go ahead with a heart cath?  My cardiologist said that if he had to give a percentage that he would find something wrong with my heart it would be 5% or less.  Is the heart cath risk worth my peace of mind.  Yesterday was a bad day with the upper back pressure coming and going, anxiety with these spells, blood pressure would elevate during these spells and they would last from 5-10 minutes.  No chest pressure at all.  My husband says that my heart has been checked out thouroughly and that it's not my heart causing these episodes.  Don't know what else to do but the heart cath.  By the way, I have had a total of 2 stress tests in the last 3 years.  The first was a stress echo after finding a "flipped" t wave on one of my ekg's.  CRP was fine too.

[bengal lady]

My only risk factor was smoking and variant blood pressure.  Of course, stress.  But, who doesn't have stress:)  It is frustrating to know that something is wrong but don't know what it is.  My cardiologist said it was up to my husband and I about the heart cath.  He would do whatever we wanted to do.  I was the one that asked him what was the chance that he would find something and he said 5% or less.  I have known this Cardiologist for some time now and trust his judgement.  He said that if it were him, he would not do it but if it were his wife, he might (just for her peace of mind).  Anyway, thanks for your imput.

[erijon]

A cath carries a 1% risk of complications, which are normally serious in nature. You have been checked out and it sounds like your heart is fine. The pain you are experiencing could also very well be neurological in nature. You have to decide for yourself if a 5% chance of finding heart disease is worth a 1% (some say up to 3%) risk of a complication from a very invasive procedure. Having said that, caths a really pretty safe overall and I know many that have had these with absolutely zero regrets. For me, much would depend on my other risk factors, if I had many and was still experiencing symptoms I would consider it only after all other causes have been eliminated. You may have some issues finding a cardiologist to perform a cath based on your profile. They have much to risk as well and  most would opt not to perform such a procedure with very little expectation of finding significant heart disease.

It's a tough decision, good luck.

Jon