Treadmill Cardiolite Stress Test /Nuclear Scan Results

[Ironman Journey]

I was referred to a cardiologist due to my experiencing chest pain and an abnormal EKG. Chest pain was in the upper left side of my chest,had a sqeezing effect,lasted less than one minute, and was a solitary occurrence at a resting state. Upon seeing a cardiologist, a subsequent EKG revealed an abnormal reading, and the treadmill cardiolite/nuclear scan test which followed produced a positive result.

Baseline EKG: Sinus rhythm, nonspecific ST T changes, and poor R wave progression across V1 to V3. Treadmill Stress test results revealed abnormal nonspecific electrocardiographic response to exercise without any chest pain. Test was terminated due to adequate obtainment of target heart rate without any complaints, and previously inverted T waves showed normalization, suggesting possible underlying left ventricular dysfunction without any classical ST T abnormality suggesting myocardial ischemia.  During recovery, T waves again got inverted. Inappropriate level of heart rate for the amount of exercise at onset of test. Cardiolite perfusion imaging revealed presence of a minute area of reversible change limited to left ventricular apex in isolated segments.

I am 46 fem. non-smoker non-drinker,who engages in high endurance sports and a  healthy lifestyle. Total cholesterol is rather high - 237. I have been adised that due to the test results, the chest pain, and my intentions to participate in endurance sports, that a cardiac catheterization is recommended.  

Is the 64 slice cardiac CTA an accurate diagnostic test as a clinical correlation, or is the angiogram necessary?

[CCF-M.D.-MJM]

Hello,

The answer to this question will vary depending on who is responding.  Either procedure will likely answer the question, although the cardiac cath will be more definitive.  If there is any question about the CT, they will probably want a cardiac cath anyway.

A history of rest pain that only occurred once is not that convincing for cardiac pain, however, if you are competing in ultra endurance sports, it is probably best for your piece of mind.  I would probably proceed with the cath if your doctor wants it.

I hope this helps.  thanks for posting.

[LukeL]

Just remember that every procedure has risks, but the risk of the procdure is FAR less then the risk of having a heart attack or unstable angina. I also would not go with a CT scan as a cath is the gold standard for detecting CAD.

[jmike1_]

Just as Al Dente, I too am a veteran of the heart cath lab.  I had my 7th heart cath this year on Friday, and luckily they didn't find any blockage.  My nuclear stress test showed some abnormality, but luckily all was okay.  I agree with Al Dente and Luke L - the heart cath is the gold standard.  I don't think everyone should jump right into a heart cath, since the 64 CT is a good test, but with your test results and symptoms (added to your active lifestyle) I would think the doctors are going to want to do a cath anyway.  I'd certainly recommend researching the facility and cardiologist you choose to do the procedure - they are not all equal.  You can usually find the most advanced heart facilities online, and I recommend calling the cardiac group at the hospital and speaking to one of the nurses for thier opinion on who the best cardiologist is - they've been very helpful/frank with me.  Best of luck with whatever you decide to do.  I wish you well!

[discobeat]

I can't pass a nuclear test, so they always lead to a cath lab visit, but the nuclear tests were always ordered because of my a-fib condition, not because I experienced symtems.  

On the plus side, when I did experiance chest pain that seemed to fit the " if you feel this call an ambulance " pattern, the doctors felt comfortable enough to tell me to take antacids with out having to do any more tests.  So there was a comfort level obtained from the tests

[Ironman Journey]

Foremost, I would like to extend my gratitude and appreciation to the doctor who quickly responded to my inquiry and was able to provide additional clarity to my situation.  I would also like to extend that appreciation to those who have enabled this site to exist.

Due to the forum and its diversity of topics, one is able to find a degree of comfort from a medical perspective, as well as from those who post their comments and experiences.

I am in deep appreciation of those who have taken the time out and have chosen to post their own experiences in response to my inquiry, thus enabling me to have a degree of clairty with respect to the decisions I must make.  Your comments have proven to be quite comforting, as well as informative.  Thank you for your kindness and genorosity in sharing your experiences.