possible heart condition and cataract surgery

[lisaloo820]

hello.
i had a pre-op physical for upcoming cataract surgery, which i desperately need and have waited a long time for.  they found an irregularily in my ekg and sent me for stress/echo.  my echo was perfect but the stress found a possible possible with a single vessel. she said it isn't "squeezing as well as they would like when i was exercising." (though i went 11 minutes and felt great and could've gone longer!)  i have no symptoms.  i am very active and thin.  i am 53 and my parents are both 82 and in reasonably good health - no heart attacks.  i will find out my cholesterol tomorrow.  it was around 215 2 years ago.  my b/p is around 130/85.  i am praying that the cardiologist who i see tomorrow will first allow me to go thru with my cataract surgery, then will help me with medication therapy first before immediately jumping the gun to angiogram.  i am scared beyond words about that even though i hear that it isn't bad - i am still scared.  also, it seems so drastic and sudden when i have no pain and no shortness of breath and am highly active and thin.  i want to have a say in this.  i know i will get more than one opinion but of course i want to do the right thing.  FIRST OFF, WILL I BE OKAY FOR CATARACT SURGERY?  i think if i have my eyes i can handle whatever they want me to do.  PLEASE HELP ME.  

[Forum-M.D.-MJM]

Hello,
I think it is important to know that there is no such thing as a NO risk procedure, but cataract surgery is considered a low risk procedure with cardiovascular complication in LESS THAN 1% of cases.  I assume from what you have written above that you have no prior CV disease or high risk features including: chest pains, previous heart disease, arrhythmias or valvular disease.  The EKG abnormality is considered a minor clinical predictor, see the recommended evaluation flow diagram at the following website -- the figure is modified from the actual guideline document:

http://www.askdrwiki.com/mediawiki/index.php?title=Preoperative_Clearance

The recommendation based on guidelines is that you can proceed with the procedure -- you clearly exercised more than 3 mets.

This is based on recommendation and clearly the clinical evaluation trumps an algorythm.  In other word the final decision is with you and your doctor, but things look good.

I hope this helps.  Thanks for posting.

[Flycaster305]

I just had a very similiar problem.  My cataracts had quickly 'ripened' to the point that I could no longer safely drive at night, and eye glare from the sun or bright lights was giving me fits.  It was a long wait for cataract surgery, and just before I had it on my left eye, I had symptoms of a blockage (shortness of breath, increased angina with minimal exercise).  The Cardiologist scheduled a stress test and wanted me to have an Angiogram at once.  I decided to have the left eye done, then while waiting the two week period for my right eye cataract to be removed, have the angiogram.  I had the eye surgery, then the Angiogram where previous stents were opened and stents installed in new areas, and then had the right eye done.  So, at least in my case, it was possible to do both.  The eye doctor insisted that I wait a week for the Angiogram if possible (it was) and he checked my eyes before I had the heart work.  
My best wishes to you, I know it is a stressful time.  I've had multiple angiograms, and they aren't that difficult.  The tough part for me is keeping my leg still for eight hours.  The cataract surgery is a piece of cake, the results are wonderful.  

[lisaloo820]

you have given me hope, flycaster.  i am eternally grateful.  

[Flycaster305]

I'm glad my experiences with the issue gave you help.  The Doctor's comments were quite interesting.  My cardiac doctor was quite animated in his request that I delay my cataract surgery, but I wanted my eyes fixed first, period.  I'm with you, I wanted to see what I was facing, vision trumped the heart procedure.   I hope your appointment went well, and hope you can post on the patient to patient heart forum, letting us know how this all turns out for you.  

[lisaloo820]

i have a follow-up quesetion.  i consulted with a cardiologist before my cataract surgery, which by the way, i went ahead with yesterday with great success.  anyway, he told me he thought based on putting all the information together, that my results might likely be a falst-positive on my stress test but the only way to really be sure is to perform a nuclear stress.  the reason he believes there's a good chance my results were false positive is because:

no family history
low cholesterol
excellent exercise capacity on stress
active
thin
highly anxious during time of test causing b/p to be high at the time
everything else looked norml
NO CHEST PAIN

i have 2 questions:
do you recommend i proceed with the nuclear stress and if they find anything what will they want to do most likely?
and can stress (again) cause skewed results:

in the meantime, i have successfully completed half of my cataract surgery and felt and did great!  thank you for all your help and guidance.

[Frostie]

I too am a heart patient and have a bad cataract on my left eye.l  I have stents and HOCM and am on Plavix.  I told all this to the eye surgeon and he is OK with this and I do not have to be off Plavix for even a day.  My surgery will be at a large hospital (outpateint) where all the heart doctors are so I feel quite safe and comfortable. I will be awake the whole time with a local numbing agent. This doctor is one of the best in the country.
  I too am in my fifties. It is awful not to be able to see. Good Luck To You.
Lisa