Thallium Stress Test

[Toneman]

I have had two cardiac workups in the past 14 months both including thallium stress tests, echos and bloodwork, both were all normal.

The first was from a visit to the ER with some mild chest pain and the second was when I followed up with a new cardiologist last month who repreated all the tests again, all normal again.

Only real risk factors are age,48, and being male. No other symptoms or health issues. Slightly overweight but loosing about 10 pounds per month with exerise and diet. No pain symptoms during exercise. Still some mild chest pain but the cardiologist believes it is gallbladder related as a recent ultrasound showed a major build up of sludge and particulates. I'm having a HIDA scan next week to confirm.

My question is, how often does one normally repeat a thallium stress test? Is this normally done on an annual basis? Can gallbladder pain be radiate to the chest as well? What are the chances of having two false negative results in a row?

Thanks for your help.

Toneman

[Happily Retired]

As a result of a period of recent dizziness, weakness, and chest pressure, I had a thallium stress test this week.  The physician who read the results of my tests called this morning with the message that "everything" was clear.

I am a 65-year-old woman, a non-smoking vegetarian who exercises regularly.  My only coronary risk factors include slightly elevated cholesterol levels controlled by Lipitor, 10 lbs. of excess weight, mitral valve prolapse, and a mother with an enlarged heart who died of congestive heart failure.   I know that heart disease is the #1 killer of women my age.

This morning I called the lab where the test was conducted (and interpreted), but I am now unable to reach the part-time physician who read my results.  I wanted to ask him what these test results predict -- or don't -- about my future heart health.  Can I now assume that I'm at low risk for CAD, heart attack, etc.?  Or is it presumptive for me to think, based on the knowledge that my coronary arteries are clear,  that heart disease is a health issue I don't have to worry about?

[Happily Retired]

As a result of a period of recent dizziness, weakness, and chest pressure, I had a thallium stress test this week.  The physician who read the results of my tests called this morning with the message that "everything" was clear.

I am a 65-year-old woman, a non-smoking vegetarian who exercises regularly.  My only coronary risk factors include slightly elevated cholesterol levels controlled by Lipitor, 10 lbs. of excess weight, and a mother with an enlarged heart who died of congestive heart failure.   I know that heart disease is the #1 killer of women my age.

This morning I called the lab where the test was conducted (and interpreted), but I am now unable to reach the part-time physician who read my results.  I wanted to ask him what these test results predict -- or don't -- about my future heart health.  Can I now assume that I'm at low risk for CAD, heart attack, etc.?  Or is it be presumptive for me to think, based on the knowledge that my coronary arteries are clear,  that heart disease is a health issue I don't have to worry about?

[PED]

I feel for you.  I'm 34 and feel like I'm just going to have to cope with these pains.  It's weird, I had some shooting pains start last october, made a ER trip in December and ever since I've had some sort of pains.

At one point I was loaded up on a whole bunch of meds and I KNOW that screwed up my stomach worse.

Down to low dose of prilosec and tagamet now.  Feeling as good as I have been in a few months, but not nearly back to where I was last December.

Had a big day today.  Even though I was again having shooting pains, pressure in my extreme upper chest (not painful, just pressure) I was able to road bike 30 miles, come home and do yard work for several hours and not "worry" quite as much.

The 64 slice helped a lot.  I sure wish I could get an answer for my symptoms as I still have them.  That said, I've had a battery of GI and Heart tests and the only positive one was for some acid reflux damage.  My stomach lining is irritated, and my esophogus shows some damage, but not extreme on either.

I still burp all the time, and if I don't burp I usually feel like I need to.

My stomach spasms sometimes I think and it feels like heart palps.

All I can tell you is that yes, it sucks.  But I'm just going with the fact the 64 slice and Thallium tests were clean, and at 34 years old if something happens at this point, well, I did what I could.

Only thing I wonder about is if an echo should be done, but I don't have a murmur.

So... on to coping.

Heck, I'm contemplating a less stressful job to see if that even helps.  But I hate to give up a good job, only to have the same problems in an easier, lower paying job.

Just try to do what I am, deal with the pain (I have some days better than others) and back to living my life.

[dmil241]

I too have atypical symptoms of chest pain and have had them for about 5yrs. My cardiologist did a 64Slice CT scan on me in January though every test he has done has been normal. This one was also normal. My arteries are clean. He says from a cardiac standpoint I will live a long time. Last November or so He thought he caught a coronary artery spasm on my third nuclear stress test and I am on low-dose Norvasc for it. However I still get daily chest pain which is almost never during activity. He does not think the spasms should be giving me as much trouble as I have. During the test which he 'thinks' might show one, I did not even have ANY chest pain. So with the medicine, I ought to be doing well. I'm not :-(

He referred me to a GI. I just had an endoscopy last Thursday. The GI said that what she found was very minor. She of course put me on a PPI and has referred me BACK to the cardiologist saying that what she found cannot explain my symptoms!!!! :-(

I am pretty much giving up hope that anyone can find anything to help me get back to normal. I feel as if I am going to live the rest of my life with daily pain and I just have to find a way to cope with it.I know I should not whine. I should be thankful but I feel pretty young at 42 and can hardly bear to think of another 35+yrs with the pain DAILY!

[PED]

I've been going through similar asymtomatic pains for 6 months now.  Frankly, it was driving me nuts.

Docs have believed it was and still is GI and stress related, but I have enough family history (I"m only 34) so after I pushed just a bit, I had the 64 slice CT done.

It was clean, as was my Thallium stress test.  That is not to say I don't still get chest pain, but I also get a lot of shooting pains in my arms, chest, and even jaw.

However, knowing that the 64 slice is clean has helped me by about 75 percent.  I'm not fearless again, but I do feel a lot better about things.

I really wish they could figure out why I'm still getting pains.  The GI meds don't really seem to help, but if I stop them now I get massive rebound.

Again, be careful what you push for.  I pushed a lot and ended up on a bunch of meds, that frankly messed me up worse.

For me the 64 slice CT has helped a LOT, not completely, but quite a bit.  Check your insurance, and then decide if the money is worth it.

For me it was.  

Good luck, once it's in your head it really stinks.

[Toneman]

Thanks for your feedback, I will take your advice. She feels there's no need so I'll go with her judgement.

Thanks

[CCF-M.D.-MJM]

becareful what you push for --- you may get it.  one indication for cath is to relieve the anxiety of the person who thinks they have CAD.  If you keep asking, you will probably get one.  Caths are very low risk but not "no risk."  If she feels comfortable with the stress test and your symptoms are atypical, I wouldn't push.

[Toneman]

Thank's for the quick reply. The nature of the pain is not typical from what you would expect from CAD. It's just a mild dull ached under my sternum. It is never accompanied by any other symptoms like shortness of breath, sweating or radiating to any other part of my body. Not crushing or pressure like at all. When it starts it normally last a few hours and is not constant, just kind of comes and goes and has been going on for about 14 months.

Again, I know these are not typical symptoms for CAD, but the cardiologist wanted to rule out the heart befor we started looking elswhere which is why she repeated the tests. She was opposed to the cath because she feels it does not seem likely enough that she'll find anything significant enough to make it worth the risk at this time based on the total work up, like you said not a high risk in her opinion.

Should I push for a Cath anyways?

[CCF-M.D.-MJM]

Hi  Toneman,

My question is, how often does one normally repeat a thallium stress test?

It depends on the symptoms.  If you are having the same pain that resulted in a negative test and  your symptoms are either no typical or haven't change, I would not repeat it all.  If you havea  negative test and I still wasn't sure, I would go straight to a cath and not bother with repeating a nuclear test.  There is a lot of clinical change and probability analysis that goes into these decisions.  It is not all straight forward for most cases.


Is this normally done on an annual basis?

There are some groups that do this, but it is not an American College of Cardiology recommendation.

Can gallbladder pain be radiate to the chest as well?

Gallbladder pain can radiate to the right shoulder and less commonly the chest.  It is worth looking into.

What are the chances of having two false negative results in a row?

It depends on  your risk factors, the history -- again, we often make decisions based on probability.  From you wrote above, you don't sound high risk.  The deciding factor for me would the characteristics your pain.

I hope this helps, thanks for posting.