need for stress test on patient with previous M I

[Frank-Krogh]

  My Father-in-Law had a severe heart attack in 1984, followed by angioplasty. Although he has done well since, he's now having chest pains on a regular basis. his cardiologist has scheduled him for a stress test. I have read that in cases where there is already a history of a previous MI, and the patient is presenting cardiac symptoms, it is not advisable to use the stress test. My Father-in-Law is from a time when one didn't question a doctors order, so he won't ask. Can you help? Thank You.

[CCF Cardio MD - MTR]

Dear Frank, thank you for your question.  It's hard to answer your question
since I don't know your father-in-law, but I'll try to elaborate a bit.
Patients that previously have had an angioplasty are sometimes reevaluated
with a cardiac catheterization (angiogram) as the first test when they
present with recurrent chest pain. However, the clinical circumstances
surrounding each patient make the decision on whether to do a cath vs. a
stress test one of individual judgement by the physician.  For example, if
a patient has had an angioplasty and their recurrent chest pain sounds
"non-cardiac" or is occuring in a stable pattern, the cardiologist may elect
to do a stress test first to determine which areas of the heart muscle are
ischemic (not getting enough blood due to a blockage in a coronary artery).
This information helps tremendously when a cath is done because blockages
that are found can be correlated with stress test data to confirm how
severe the blockage is.  Often blockages are found during a cath, and the
functional significance is not known because a stress test hasn't been done.
For example, if a patient is found to have a 60% blockage on a cath, the
cardiologist would have a difficult time determining if that lesion was
significant enough to perform an angioplasty without stress test data.
Thus, I would speak to your father-in-law's cardiologist regarding your
questions and see what he/she has to say.  Hopefully, they can explain
their choice along the same lines as how I've answered your question.  But,
if your father-in-law develops protacted chest pain that lasts for more
than 10-15 minutes (even with nitroglycerin pills and rest), he should
go immediately to the nearest hospital or call EMS.  I hope you find this
information useful.
Information provided in the heart forum is for general purposes only.
Specific diagnoses and therapies can only be provided by your physician.