Validity of echocardiogram vs thallium stress test

[helen]

I'm a 57 year old nonobese, nonsmoking woman. My PCP referred me for a stress thallium test due to: elevated BP and cholesterol; chest pain (not severe), on sudden exertion and with spikes in B.P., but not with gradual increase in prolonged exercise - sometimes radiating to neck and jaw and behind the scapula; periodic tingling/numbness in left arm; severe family history of cardiac disease (mother who died at age 65 of undiagnosed cardiovascular disease, never complained of chest pain; brother has had multiple bi-pass surgery twice), uncle died in his sleep of undiagnosed heart disease at age 50.

My stress thallium test revealed a small area of infarct with a larger surrounding area of ischemia - probably not acounted for by breast shadow - that report indicated that it was probably not a false positive test.  The EKG portion was negative and I had no pain while exercising - I did have pain while the pictures were being taken.

My cardiologist (who is well respected in this community) then performed an excercise echocardiogram which was normal.  Again, I had no pain during the test.  He put great stock in that result and thinks I do not have cardiovascular disease and doesn't think a catheterization is warrented at this time.  His plan is to do additional noninvasive tests if the symptoms persist.  The cardiologist who performed the thallium stress test also predicted that test would be normal, but then was very concerned with the results of the x-ray.

I don't have any symptoms of GERD that I can identify (unless that's what is causing the pain).

My questions are:  1.  Is the echocardiogram a more valid test than the thallium stress test in a scenario like mine  2.  Will additional non-invasive tests (assuming they are negative), be as definitive as a catheterization would be.  3. Would a second opinion be warranted?

Thanks in advance if you decide to answer this question.  -Helen




I'm doing the appropriate things with diet, meds, exercise, etc.

My questi

[CCF CARDIO MD JMF]

Both exercise tests with thallium and with echocardiography are excellent tests to rule out the presence of CAD.  However, they, like other test in medicine are not 100% accurate.  They may cause false positives ( meaning that they say there is disease when ther isn't) and false negatives ( they miss disease when it is present).  Cardiac catheterization is generally thought of as the gold standard.  However, in your case where it sounds as though your symptoms are atypical and may stem from GERD, these are likely to be very good tests to rule out significant coronary disease.  It may be best to discuss all these issues with your cardiologist.

[heather]

I was wondering about the tredmill test.I had to walk on a tredmill.I became very short of breath during the test.I had pains in my legs which were very heavy. The doctor present stoped the test at 2mins 33seconds.This was due to my heart rate being very fast.I was told that he normally only see's that responce after about 20mins not just two.I asked him what was wrong and he told me he did not know.All he told me was that I was not very well.I was sent there because I was found to have a Grade 2/6 systolic heart murmur.I was taking dizzy spells, and having pains down the left side of my body, and pins and neddles in my left arm.I get out of breath when I climb the stairs, or doing some house work.I was sent for a test where they injected my arm to exercise the heart.I was lying down at the time then I was scanned.I was told this was negative,That I did not need treatment, because of this result.I still have the same syptoms (symptoms).But I have been given no diagnoses.All I have been told by one doctor is that I was not very well.I think I agree that these test can give out wrong readings as I feel my health getting worse.Has anyone any idea.

Kind Regards Heather

[jan]

Will somebody give me answers to my questions? 1.What is it that they do that takes 4 - 6 hrs?  2. What was the experience like? 3. Anybody with an arrhythmia? I have to go off the atenolol 48 hrs. (I have IST) and I am concerned how my heart is going to react to that. (I've read about being "weaned" off of it, does that mean 48 hrs. isn't a big deal?) 4. They said no metal from neck to waist.  Does that include an underwire bra?  If you can give any other insiteful info., I'd appreciate it.
Thanks.

[Info about thallium stress test]

Just had one 5/10/00. The nurse will open up a line in your arm and give you an injection of thallium an saline, then you wait 20-30mins. You lay down on a table with your arms over your head and a camera moves over your chest very slowly for 20 mins. taking 30 pictures. Then your taken into a room with a treadmill. The nurse puts a bloodpressure cuff and about 10-11 wires on you to monitor your heart. You start out slowly on the treadmill, every 2 mins. the speed increases and the incline increases. Everytime this happens your bloodpressure is checked, there is a cardioligist present throughout the treadmill part.I was on the treadmill a total of 9 mins. and reached a max speed of 5 mph. Before you get off the treadmill your given another injection of thallium, after you get off you wait another 20-30mins. then back to the table for more pictures. It wasn't a bad experience, just a lot of waiting. Can't help you out with the bra I'm the wrong gender, but I did have to take off a metal necklace. Hope this answered some of your questions.

[jan]

Thanks for the info., but did all that take 4 - 6 hours?  If so, should I take some reading? Or do they keep you busy all of that time?

[Info about thallium stress test]

All this took about 2 1/2hrs. you will only have about 1 hr. that you could read.I am on high bloodpressure meds. and had no problems skipping them until after the test, but as far as the atenolol you should consult the cardiologist ordering the test.Try to relax, the test isn't that bad and the staff understands it's time consuming and will try to make it as pleasent as possible. Good luck

[[e-mail]]

Sorry to be asking a question in this area (but) i CANNOT FIND THE QUESTION PLACE--- mY QUESTION IS IN NOV. OF 98 i HAD A THALLIUM STRESS TEST, THE DR. ON THE TRED TEST SAID IT WAS FINE, BUT WHEN THEY READ THE THALLIUM TEST THEY SAID (MILD ABNORMALITIES) BUT WHEN i WENT BACK IN TO TALK WITH THE CARDIOLOGIST HE SAID HE THOUGHT IT WAS A FALSE POSITIVE. wELL THIS HAS WORRIED ME EVER SINCE THEN. DO YOU THINK i SHOULD ASK FOR ANOTHER ONE???i HAVE WORE A HEART MONITOR TWICE FOR 24 HOURS AND IT WAS FINE. pLEASE REPLY i REALLY KEEP WORRING ABOU THIS.
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6/27/00