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how accurate are heart cath's
how accurate are heart caths, i took a nuclear stress test which showed reversible ischemia ,and the my heart gets bigger when exercising when it should get smaller. it also showed heart thickening. i had a heart cath and he said my heart looked good, should i get a second opinion or are they 100 % accurate.
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976897 tn?1379171202
I think if I was in your shoes, I would first maybe wonder if 'both' tests are accurate and have given true readings to the best of their ability. The perfusion (nuclear) scan has revealed reversible ischaemia which means blood flow to an area of heart muscle is restricted. The angiogram shows that your major coronary arteries are clear. The two tests may lead to the same conclusion, or the nuclear scan could have given inaccuracies when trying to penetrate body tissue to reach the heart. Let me explain how both tests could be correct.

An Angiogram can only look at fairly large vessels, the small vessels do not show up. The larger coronary arteries do not directly feed your heart, they break down into smaller and smaller vessels untl they are the narrower than the width of a hair, and then they feed oxygen to the heart. Imagine the roots of a plant. The large roots are your main coronary arteries which feed all the smaller roots hanging from it. When you get to the tiniest roots, these are feeding your heart. So, the angiogram may not be seeing problems that could be occurring in the smaller vessels.
If your cardiologist says that there is nothing wrong with your heart and that the nuclear scan is at fault, I would ask "How do you know that? how do you know the nuclear scan isn't correct and my smaller coronary arteries aren't blocking?". Its so easy to disregard one test for another but you can end up losing the trail leading to the cause of any problems that way.

I hope I have explained this in a way easy to follow, I get very finger tied when trying to explain things at times.
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thank you for the explanation, i understand it a little better now. let me ask one more question what do they do if the small vessels are blocked and do you know how they can tell?
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976897 tn?1379171202
I'm not sure if they can tell. The problem is they are so tiny, microscopic. Are you getting angina symptoms when you exercise? or do symptoms appear at any time?
If with exercise, there is a 'possibility' it could be your tiny vessels. If symptoms appear at random, then it could be you have unstable angina. The best method to test if you have narrowing vessels is to take Nitro when you feel discomfort. This forces your arteries to open fully and should relieve any symptoms. The side effect is a headache for about 20-30 mins while your blood pressure has dropped.
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976897 tn?1379171202
Sorry, I meant to add.....
It could be that the nuclear scan was in error, but I'm simply saying don't let them dismiss the possibility that it 'could' be accurate. Just becaue it doesn't match your angiogram doesn't make it wrong.
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367994 tn?1304957193
Quote: "How accurate are heart caths, i took a nuclear stress test which showed reversible ischemia ,and the my heart gets bigger when exercising when it should get smaller. it also showed heart thickening. i had a heart cath and he said my heart looked good, should i get a second opinion or are they 100 % accurate".

>>>What do you mean your heart gets bigger when exercising when it should get smaller?  What test or how was there a conclusion of heart thickening?  Did you have an echocardiogram?  If so, what are the dimensions of your left ventricle?

For a perspective of stress test and cath. With over 1.3 million stress echocardiography tests performed each year with a 10-15% failure rate, there are potentially over $100 million unnecessary or clinically unreliable stress echocardiography tests done each year. This stress echo failure rate results in an increase in the number of nuclear perfusion stress tests, which are known to have a high incidence of false positive results. A false positive cardiac stress test may increase the number of expensive, unnecessary cardiac catheterization procedures and their associated required hospital stay and added anxiety, discomfort and medical risk for the patient. The significant number of false negatives from stress echocardiography tests may increase the risk of heart attacks and sudden death from undetected advanced coronary artery disease (CAD) and/or successful earlier intervention in early stages of CAD.

I would get a second opinion as there are serious implications and consequences with any mistakes.
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the cardiologist said that my heart got bigger when it should get smaller. dont really know what he meant by that. the only test i have had was a nuclear stress test chest xray and a left heart cath. he said i had uniformed thickening results from the stress test. thanks for all the advice.
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