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Stress Test Results a "Mistake"?
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Stress Test Results a "Mistake"?

I am a 58 yr old women with high cholesterol & triglycerides. I also am about 30 lbs overweight and have high blood pressure My father died at age 54 from a heart attack. My older brother and younger sister have both had angioplasty with stents.

A month ago, I was admitted to the hospital due to pain mostly in my right arm going up to my jaw shoulder and intermittent pain in my chest. along with nausea. Blood work  showed no evidence of a heart attack, but I was urged to stay because of my family history.  Monitored heart rated was below 60 my entire stay, except during stress test.

Results of a stress test read “The left ventricular ejection fraction equals 65% with satisfactory heart wall motion. However, there appear to be areas of ischemia in the anterior and inferior walls. There is also evidence of slight dilatation of the chamber at rest.”

A cardiac catheterization showed no evidence of coronary artery disease. The doctor who did the procedure was very careful to say only that I “had no coronary artery disease.” He also said  that cardiac catheterization “did not evaluate muscle.”

At the follow- up visit my cardiologist, he  repeatedly lamented the fact that the stress test was not done in HIS office on HIS equipment. He stated the doctor. who read the stress test made “a mistake which caused me needless risk and expense” ( in spite of the fact that he was the one who told me I needed immediate catheterization, because he agreed with the findings.) He dismissed all findings from the stress test. He stated I could not have heart damage without having some kind of major event, yet I read about silent ischemia.  

I understand that large and dense breasts like I have, can create false positives on nuclear stress tests. Is there a need for any further evaluation, since my symptoms have returned from time to time? Is there any reason to be concerned about the findings that were discredited as a “mistake” and rush to make an appointment with another doctor?
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Nuclear stress tests are not 100% accurate.  Indeed there can be false positive and false negatives.  The heart function is also reported on a nuclear stress test(ejection fraction).  In your case, it seems based on what you are reporting, although your nuclear stress test showed ischemia in the anterior and inferior walls of the heart, your cardiac catheterization, which by the way is the gold standard test looking for coronary artery stenoses, was normal, so you do not need to repeat the stress test.  One other finding that also would raise suspicion for coronary artery disease based on the stress test was the cavity dilatation with stress.   The false positive stress test was most likely related to attenuation from the diaphragm and the breast tissue which can sometimes be read as an abnormal test but when a coronary angiogram is done, everything is normal.  That is how we define false positive tests.
Therefore, one can say for sure that there is no obstructive coronary artery disease.
That being said, there is a condition called Prinzmetal's angina or variant angina, in which the coronary arteries can be relatively normal with no significant obstruction, but from time to time can undergo vasospasm, which basically means that they suddenly narrow transienty.  This narrowing is often relieved by nitroglycerin.  If your cardiologist feels this is a potential source of symptoms, one can try using long acting nitrates and calcium channel blockers which could improve symptoms.  Alternatively, there is a test called an ergonivine challenge which can try to bring out coronary vasospasm in the cath lab, but this is an invasive test and should only be reserved for patients in which the diagnosis remains unclear.  Hope this is useful.
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