To Heart Cath or Not to Heart Cath, That Is The Question

Two years ago, at age 43, I requested a heart scan.  It was being offered for $100, and my paternal side has some history of heart disease.  Three corornary arteries had calcium scores of 0, and the left anterior descending had a score of 14.97 (putting me in the worst quartile).  

This year, age 45, had a nuclear stress test.  This was done at my request due to history and the poor coronary calcium report.  Treadmill results:  Duration 11:35, METS 12.8, Resting Heart Rate 59,  Peak HR 155, Resting BP 116/74, Peak BP 142/64, 89% max predicted HR

The ECG showed 1-1.5 mm flat or downsloping ST depression suggesting myocardial ischemia.  I had no chest discomfort during the test, nor have I ever had discomfort.  I am fit (5'10", 160 lbs, tennis, etc.).

The perfusion stress images showed a small moderate defect in the apex, ischemia detected in the apex.  No evidence of infarction "evidence of mild apical ischemia".

I am scheduled for a heart cath, and potentially a stent, in 10 days.  Obviously, I'm doing some homework.  It is my understanding from online research that the left anterior descending feeds the apex, so everything seems to support that the stress tests results are valid.  Any thoughts?

[ed34]

I am not a medical professional but there is such a thing as silent ischaemia, where no symptoms are felt. Some people have full blown heart attacks and feel no pain at all. To rule out the possibility of the image being in error from the scan, which can happen, it is worth the angiogram. There are different types of coronary artery anatomy, if you look up right, left and co-dominant you will see a few examples. I believe that in most cases the right artery also reaches down into the apex on one side, I know mine does according to my angiograms. However, during the angiogram I'm sure they will shoot some dye down both sides to see if there are any problems. They will also check the circumflex. If this is your first angiogram, I can tell you a few simple tips. Empty your bladder before going into the cath suite, the dye sure makes you want to go quickly. When in the cath suite it is quite cold because the equipment has to be kept chilled, don't be scared to ask for blankets. I normally have about 3 to keep me warm. If you feel over nervous, even though there's nothing to be afraid of, you can ask the Cardiologist to give you some extra meds to relax you more. It really is fascinating seeing your arteries on the large monitors, actually seeing inside your own body. I've had 6 visits to the cath suite now and I can tell you that all you feel is a tiny pin ***** as the local anaesthetic goes in. After the procedure your leg aches a little bit for a couple of days, but nothing dramatic or to stop you walking around. You have to lie flat for quite a while afterwards and trying to have a drink on your back takes some practice with a straw.

[Cleveland Clinic]

All of the above findings make sense and you should have a catheterization.  Whether stenting in a patient who is asymptomatic is indicated is questionable.  Because you aren't having any symptoms and because the blockage is likely to be very distal medical therapy with beta blockers may be all that's indicated.