should I have cardiac catherisation done??

[Widget]

After having had a Bruce protocol exercise stress test , Holter monitor, and Echocardiogram I was diagnosed with Silent Myocardia Ischemia   Stress test was positive for Ischemia , with a peak heart rate of 157bpm  at 2:35 mins into test, at which point the test was halted.
1.Normal left ventricular size, function, wall motion
2. The ejection fraction lower limits of normal, approximately 55%
3.Left atrium is mildly dilated. The aortic root, right heart chambers are not dilated
4.Aortic sclerosis with no stenosis in any of thye four valves seen
5.There is moderate 2+ mitral insufficiency
6.There is moderate 2+ tricuspid insufficiency
7.Mild to moderate 1-2+ pulmonic insufficiency
1965  Hit by auto, compound fractures both lower extremities, developed pulmonary embolie ,ligation of inferior vena cava. Smoked pack and a half for 35 years, quit 3 years ago. Now diagnosed with chronic lung disease, Bullous Emphysema: Medications. Coumadin 5mg, Synthroid75mcg, Atenolol 25mgLanoxin 0.25mg alternating daily with 0.375, proamatine 5mg twice daily, Raniditine 150mg My cardiologist recommends treating my silent myocardia ischemia medically. He prescribed the atenolol after the tests and the other meds I have been taking for some time now, My cardiologist estimates that I have 70% blockage in one of my coronary arteries. My question is,should I have a cardiac catherisation doneand a balloon angioplasty if necessary and should I have a pacemaker installed to control the atrial fibs which have been with me for about ten years.

[CCF-M.D.-CRC]

Dear Widget,
We tend to take a more proactive approach here regarding heart cath and have a very low threshold for the need for cath.  In general we would cath someone with an abnormal stress test before  making the decision on medical management vs. revascularization either with a balloon or bypass surgery.  The pacemaker is a separate issue and would depend on the heart rate response to the atrial fibrillation and the response to medications.

[PET GUY]

Why must you perform the cath prior to deciding medical management?  Do you approach the cath differently from a SPECT abnormal and a PET abnormal?

[Widget]

Hello Pet Guy, excuse my ignorance of medical abbreviations, but what are SPECT and PET abnormalities?. It is my understanding that that the heart cath is the most effective type of diagnostic tool  that the physician has at his/her disposal. Thanks for your imput~~~~Widget

[J. W.]

Widget,

The cardiac cath is not going to hurt anything if you have a day to have it done. What is your rate with AF? Is it uncontrolled? Are you on coumadin of another blood thinner? I am sure they will want to d/c it prior to cath.. The pacemaker seems premature. A very expensive process when medication in most cases can be given to control the HR. Good luck and stay informed of medical decisions involving your well being!

J. W.

[Widget]

Thanks for your response JW. I have been on Coumadin now for about ten years. A recent heart rate reading was as low as 38 while in a-fib. The medications do not seem to be controlling the fibs, and I have also been having them now for ten years.Considering my condition , would not a pace maker be a good idea??___    Perplexed, Thanks again