nuclear stress test for 90 yr old. what would change?
My Dad is 90 yrs old. He has kidney disease, stage 4; osteoporosis with a wedge fx; peripheral neuropathy; sleep apnea; GERD; erosive esophagitis; high blood press and diabetes. He is a caretaker for my Mom who has middle stage ALZ (although we all help him as he allows.) He's been hospitalized twice (at the VA hospital) in the last 3 years for GI infections/fever. In his first hospitilization he once had severe upper left quadrant pain although no cardiac followup was done past the ECG - which shows something (thickening or heart attack damage in the left ventricle area). His hospitalizations (at the VA) resulted in no clear GI diagnosis but he did improve with antibiotics. A non-VA GI Dr has suggested he might have re-occuring C-Diff that isn't showing up on the testing. As his medical advocate I've promised to allow nothing that will extend his life but everything that will increase the quality of his life.
Recently he's reported some mild to moderate chest pain -- pressure in the upper left quadrant along with nausea -- lasting several hours. Also his diastolic BP readings have been in the 40's and 50's. (40 on the EKG) His primary care Dr sent him to a cardiac dr who spent 1/2 an hour talking without much focus, and without answering my primary questions. The Cardiac dr scheduled a nuclear stress test (chemical) and and echocardiogram. My father does not want to do the stress test. He thinks it is a waste of time and effort. My question is if we do the echo and/or the stress test, what would we know that would help us improve to quality of his life? He's too old for any surgery or other invasive procedures. He's already been thru countless BP meds to finally find the one he's been on for 5 yrs now (Atenonol 12.5 mg twice a day). After reading and reading I'm inclined to encourage him to do the echo but not the stress test. It seems like we can infer about ischemia from the echo. I'd like to hear a professional point of view if someone would please offer one. Thank you.
An echo will provide information regarding the functionality of your father's heart that includes size of chambers, heart wall, blood flow through the valves, and a calculation of the amount fo blood pumped with each heartbeat.
The information is useful to determine the underlying cause for shortness of breath, chest pain, muscle fatigue, etc. Your father's symptoms may be due to low cardiac output as the heart may not be pumping efficiently. An echo would verify or exclude.
A stress test is helpful to diagnose chest pain that is due to vessel blockages. There is an injection of a dye substance that perfuse through the vessels during an exertion type activity and blockage is visable. If there is a blockage, there can be a stent implant to open the vessel to better blood flow and that would treat the chest pain.
Thanks for the question, and if you have any followup questions you are free to respond. take care and I wish your father well. Take care.
Thanks for your response and your compassion. I do understand the purpose of both tests. In my father's current health I'm pretty sure no one is going to implant a stent. I doubt he would make it through the surgery. My questions are - given no invasive procedures can be done in follow up to a stress test-- (as my Dad would say) "what's the point"? And, can we infer ischemia or vessel blockage from the echo?
Yes, you can infer there are blockages if nytro medication relieves chest pain (angina). Nytro relaxes coronary vessels and the relaxation enables better blood flow to the heart cells that may not be getting enough oxygenated blood.
An echo will only provide information regarding the results of coronary artery disease (ischemia), etc. and appropriate treatment if necessary. A stent implant although evasive is of little or no risk if the procedure is done by a well qualified interventional cardiologist. Your father would not be place under medication other than anti-anxiety medication, and he would be awake and frankly feel very good due to the medication. Your father would be discharged within 24 hours, and able to resume his usual activities. That has been my experience.
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