heart artifact

[Bettycit6760]

I started to have an irregular pulse.  Referred to cardiologist. 24 hr heart monitor had an a tiny episode of palpitations.  Standard stress test another episode of tacycardia (drs. term).  Otherwise did great on stress test, no high bp, colesterol tests good, age 67.  He wants to do angioplasty.  Is it really necessary?  He called the episode on the stress test an artifact(?).

[kenkeith]

Thank you for your comments.  I had a wonderful Thanksgiving, and hope you did as well.  I wish I were in AZ!...situations have changed so it is difficult to go to AZ in the wintertime as previously.  Take care, and keep us informed.  

[Bettycit6760]

Finally I have some results.  No clogged arteries.  However my left ventricle is only working at 40% instead of 60%.  I have been started on a beta blocker.  Will follow up in 3 months for med review and one year for heart check.  No restrictions on activities.  Of course, I now have many questions but I will give myself a break and save them for my med review.  I hope you are doing well and enjoying Thanksgiving.  I wish you the best for the coming holiday season.  Thank you for all your support and advice.  I'll keep in touch and you do the same please.

[kenkeith]

Thank you for your response, and please do keep us posted.  Good luck.

[Bettycit6760]

Finally got to the new doc.  Like him a lot.  He is going to do a nuclear stress on Oct. 27 & 28.  If I have no clogged arteries I am fine.  He gave me a 50/50 chance.  Of course the stent will come after that if I do. He is also doing an echo.  I feel so much better now.  The stress was about to kill me.  I am still not feeling the palpatations but the doctor says they are there.  I will keep you posted.  Thanks again.  Hope you are feeling well.  You have been so kind to me.

[kenkeith]

Please take the time to keep us updated.  Wish you well!

[Bettycit6760]

I saw my primary care doctor today and she said she didn't have any results from the cardiologist but an angiogram seemed extreme.  She is requesting my records and has referred me to another cardiologist.  It will be interesting to see what he has to say.  I feel releived to know that she, at least for now, is agreeing with me.  Once again thanks for all your help.  I will keep you posted.  Hope everything is well with you.

[Bettycit6760]

I'm sure the doctors will put whatever symptoms on the request they think they need for approval.  Of course he doesn't have any hard evidence such as preliminary testing to show blockage that they may require.  Who knows, Ken, what lurks in the hearts and minds of cardiologists.  I will be writing you again soon with good news I hope!  Thanks again.  

[kenkeith]

It just doesn't add up to have an angiogram based on the statements you have provided.  Medicare may welcome a second opinion, and you can't rule out medicare may not approve an angiogram.  Every test and submission to medicare my cardiologist states the test was given due angina...I don't have angina but I take medication for it prior to going to the gym.

Frankly, I don't know how your doctor can justify an angiogram and possibly a stress test may not be approved without relative symptoms?!  Winters were spent in Phx for many years, and Arizona is a beautiful state...you are fortunate to live there...except for the summers :). Take care

[Bettycit6760]

I have no chest pain. I have no sob. I have no chest pain with exertion.  I felt great before all this started with the irregular pulse.  I don't feel bad now only the worry of it all.  It has made me crazy worrying I am about to have a heart attack or stroke.  And I worry about the angio as it can cause stroke or heart attack sometimes.  I have made an appointment with my primary care physician next Wednesday to discuss the possibility of finding another doctor for a second opinion.  Hopefully medicare will cover the cost of the second opinion.  I think you are right that a perfusion test is the next course of action.  I can't feel this good and have that bad of a problem.  .  You seem to be a busy man  and I thank you once again for taking the time with me.  It has meant a lot.  I'll let you know what is going on.  Do you winter in AZ?  If so where?

[kenkeith]

An angiogram is usually the last test for chest pain (angina).  Occluded vessels can cause a decrease of blood flow to the heart muscle and that causes chest pains (usually, but not always).  Do you have chest pain with physical exertion?

A perfusion stress test will be able to image the blood flow through your vessels as there will be a contrast agent injected into the blood stream.  If there is blockage, it almost always will show with exertion.  If there is blockage, that may involve angioplasty (angio with stent), but it seems that would be the final test to determine the size and location.  There are other reasons for an angio, and that could be ultra sound attached to the cath to visualize the arteries' anatomy to image the inner linings of the vessel...regular angiogram visualizes the inner chamber. Also, the procedure can measure the intra-chamber pressures.

[Bettycit6760]

Thank you so much for answering.  I don't have anyone to help me with this and it is very frightening to me.  What is a perfusion stress test?  Elevated chol for 2 yrs,  Was 217 ldl up hdl down.  All within range now.  the doctor said he doesn't want to do any more tests because if there is a blockage he would still have to do the angio.  So might as well do the angio then we know for sure.  He won't do angio until October.  How bad
off can I be?  I don't know why he is so adamant about the angio.  He said he has had all of these tests (about 55 yrs. old).  I asked him if being in the cardiac field scares him and he said yes.  I wonder if he is projecting his fear onto me.  If so it is working!!  But  not quite enough for me to run to an agiogram.

[kenkeith]

You may have an interventional cardiologist.  A minority of them think stents is the best answer, and it might be if it is known there are lesions.  But from what you have stated there is no evidence of coronary vessel blockage.

You may want to get a clarification for the need of angioplasty v. perfusion stress test. Also, you may want to get a second opinion....you take meds for chol what is the basis for that medication?

[Bettycit6760]

I have not sob or chest pain.  He says I have palpitations but I don't feel them,.    Family hx of heart disease.  Sister recently had nuclear stress no blockage.  Brother had by pass. I  Take meds for cholesterol.  I asked for nuclear stress he said no angiogram was better.  I walk 90 min every day.  Was weight lifting but he said no stress activity.    

[kenkeith]

The meaning of an artifact in relation to a test is that there was not an heart rhythm event but the monitor indicates there was an episode.  Why does the doctor want to do angioplasty...do you have blocked coronary vessels?  Do you have chest pains?  If the answer to the questions negative, you probably don't need angioplasty.  Angioplasty usually involves opening a blocked vessel and implanting a stent.

It seems odd to go from rhythm testing and evaluation to a vascular treatment?!