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Test s detecting blockages
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Test s detecting blockages

Dear Doctors,

I know that Clevelnad Clinic is the leader for Heart Clinics in the U.S.

Can you answer the following questions that concern me.

1. Recently the NJM, announced that studies now show that Estrogen does not protect females from heart disease. I am considering getting off these as this was the only reason I was taking them. (had a total hysterectomy at age 35) I am now 55 years old.  MY OB/GYN does not know how to answer this.

2. Last week I saw a cardiologist on the recommendation of my GP. GP wanted a Stress Echo done.  The cardio doctor only did an Echocardiogram and a regular EKG. (Normal he said) GP wanted a stress echo for on and off sporadic chest /upper tummy chest discomfort.  My BP in the cardio docto's office was 170/90 and 160/90 15 minutes later and then back up to 170/90 when the doctor took it.  I have never had my BP this high.  The cardio doc put me on Zestril with thiazide. MY Cholesterol tests that I had prior to seeing him was also high and I never had it this high before.  The cardio doctor put me on Zorcor, 10mg.   I mentioned white coat hypertension and he said he did not believe in this. He said if one is nervous it may go up slightly but not to 170....

He did not paint a pretty picture and I am scard to death. I have never been on meds before except estrogen and synthroid.

He wants to do a regular stress test in his office and if I fail this test he will do an angiogram. ( I noticed the word Stent on his business card)  I asked him about the MRI of the Heart/arteries.  He indicated that the MRI was not good at detecting blockages. Did I read something wrong on previous posts?  Are MRI's of the Heart FDA approved?

CC Doctor, can you please comment on the MRI or any other non invasive tests that show arteries as good as an angiogram?
He also will not do a Stress Thallium.  I have 4 weeks to figure this all out before I return back to him. My fear is this doctor will insist on an angiogram and place some stent in while I am out.

He also wants a pulmonary function test and RX'd Maxair puffs.

I purchased a good home BP monitor and am keeping a diary. I have now taken 4 readings in the AM and they are below 140/90, i.e 135/78/, 136/80, 140/88, 127/78.  I know it is not the new drugs as they do not work that fast.

With cardiology, is there different strokes for same type folks?

Thank You for taking the time in answering these questions.  I hope your answers also help someone else.

Addie



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Dear Addie,
Although doctors are not as optimistic about the long term effects of estrogen the jury is still out on what is the best answer.  The recent HERS trial did indeed show that there was not as strong of a cardioprotective effect but most of this was due to increased risk of blood clot during the first year of therapy.  Some doctors therefore are recommending that if their patients do not smoke and have been on estrogen for at least a year they continue taking it.  There are other beneficial effects of estrogen as well, such as decreased risk of osteoporosis.

Concerning you second question - I wouldn't jump to conclusions yet.  Your doctor said 'if' the test is positive.  IT may very well be negative.  However 'if' it is positive I agree that you are at high risk for having coronary artery disease.  Angiography is still the gold standard and is the best test currently available.  MRI may be able to do the same in 10 years time but not right now.

Your blood pressure is on the high side and a thiazide diuretic is not a bad idea.  Be sure to watch your salt intake and exercise as recommended by your doctor.
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