stress test

Hi, I have had a mild idiopathic dilated cardiomyopathy for the past 4 years, and take 20mg. vasotec twice a day. I am a 35 year old male in otherwise good health, the heart size and valves are normal,I am thank god asymptomatic and feel fine. I have mentioned to my doctor that once or twice in the last few months i have woken up in the middle of the night with a pressure (fullness not pain) in my chest and a rapid pounding heartbeat which lasts for about 20 minutes. He feels it might be GERD as I do have acid reflux, however to be safe and to rule out the heart first, he has fitted me for an event monitor, and scheduled a sestamibi stress test. My question is: is a stress test a logical first step? I have a relative with cardiomyopathy who said his cardiologist did a catheterization as soon as he was diagnosed with myopathy. My doctor did a stress test at that time I was diagnosed which was fine, and a PET scan which showed no abnormalities of coronary flow reserve. (He did this test because i'm a nervous fellow and he wanted to reassure me) My doctor states that he doesn't believe in routinely jumping to an angiogram which carries some risk, and upon his clinical evaluation and treatment of me he doesn't feel i need one. I like and trust my doctor. Is the testing for cardiomyopathy standard and clear cut, or do cardiologists have differing opinions as to the need for an angiogram? Also, is a sestamibi stress test if negative, a fairly reliable indicator of absence of heart disease?(i know its not the gold standard).

[CCF-M.D.-KE]

Dear Inky,

When the  diagnosis of decreased LV function is made, cardiac catheterization is part of the evaluation. This is because coronary artery disease (blockages in the heart arteries) is the most common cause of decreased LV function in the U.S. and must be ruled out. I think you should  have a heart catheterization.

You describe palpitations and chest pain during the night. These symptoms in the setting of person with decreased LV function could be suggestive of ventricular tachycardia (malignant rhythm disturbance). This is worrisome and I would recommend having a holter monitor study done very soon. This is a device worn for 24 to 48 hours which records the heart's electrical activity. This will diagnose what  is causing your palpitations. Also, you should be taking a beta blocker as a part of your medical regimen if you are not already doing so. I would not delay in sharing your concerns and the stated suggestions with your doctor.  Hope your symptoms improve, keep me posted.


Thanks for your question,

CCF-MD-KE

[briane]

I hope you get help for your symptoms soon!!  I was alittle comfused is decreased lv function and cardiomyopaty the same thing?  I tried to find info on net and couldn't.  God Bless

[SPOP]

I am a 47 year old male (5' 10", 165 lbs.) who plays recreational basketball.  Lately, on occassion, after I returning home my heart has started racing. It happens up to 1 1/2 after exertion.  My heart thumps haard 4 or 5 times then returns to normal until the next episode which may happen in 30 seconds to a minute. This lasts for 10-15 minutes. It doesn't happen every time I play, but it is something new. I've often felt my heart pound during games, but not well after.  Last night while playing I also got dizzy. I fast break a lot when I play so it's a lot of stop and start.  Is it possile this could be related to anxiety/stress? Or does it sound like a heart rhythm problem?

[wmac]

I think that you should be checked out by a doctor.
excerised induced palps. from my understanding could be dangerous. You should have a stress test. Im doctor but i sure would be safe about this.

[SPOP]

Did you say you are a doctor or did you mean I'm no doctor, but...?

[wmac]

very sorrry im no doctor! Iv just gone through alot stuff with this and from what i read from the forum and from my doctor you should be check, i just did a stress test my self. I didnt mean to alarm you if i did, but most people just blow symptoms off and you shouldnt with this.

[SPOP]

Took your advise. Thanks.