Seeking second opinion on Cardiac Cath

Greetings,

I am writing to get another perspective on my current situation at my cardiologist.

I am 35 yo, decent shape, no smoking, no drinking. Though I did a considerable amount of both from 18-25.
I am not a track star, but I can run a contiguous mile, and exercise occasionally.

I recently started experiencing PVC's. I went to a cardiologist just to make sure they were benign PVC, and was given an EchoCardiogram, EKG, 30-day event monitor, and a nuclear stress test (treadmill, not chemical).

Today was my final follow-up post-testing. The Echo and EKG he said were textbook perfect. He also said the PVC were definitely benign, nothing to worry about. Then he threw me a curve ball:

The nuclear stress test displayed conflicting information. After 9 minutes on the treadmill, he said my pictures under stress were remarkably clear, excellent blood flow, clearance, etc.  Then he said my resting photos suggested a "1% or less chance" of a left coronary blockage.  He said he is 99% certain it is a test anomaly, since my stressed pictures looked great and so did the echo. But due to the discrepancy, the test is now "inconclusive" and he suggests I have a left side Cardiac Catheterization to rule out any blockages!

He also mentioned the CT, but seemed to push me towards scheduling a cath without any sort of elaboration or anything.  I sensed profiteering..... or maybe that's wishful thinking, because I am afraid.

Do the risks of Cardiac Cath outweigh the possible rewards, given EVERY test showed textbook healthy heart except likely-anomalous resting nuclear photos ?

I am predisposed to anxiety, and now I'm freaking out.  I need an unofficial second opinion if anyone can help me.

Thanks!
J

[Douglas Bogart, MD]

In general the accuracy of a nuclear stress test is about 80-85% but clearly there can be false positives which you may have.  A stress echocardiogram might be a way to answer the question as to whether you have coronary artery disease without  giving you more radiation from either a CT or cath.

[sonick808]

I also wanted to add that I have been completely asymptomatic of any coronary disease.

No angina. No breathlessness. No marked degradation on exertion. In fact, I have been running quite a bit more lately as it seems to make the PVC's occur less frequently. I have ran several miles a day for the last couple weeks without any sort of chest pain, breathlessness or any such thing.

I am so confused. I thought the stress test would suggest problems on exertion, not rest. Surely this is a test fault. Perhaps I should do the CT instead of Cath. My cardio was more or less poo-pooing the CT though; basically pushing me to schedule a cath for the very next week....... on a 1% anomalous chance of test error ?

Any opinions appreciated!

[carolm1973]

I asked legitimate questions and waited for advice which I never got..
I think this was not helpful

[sonick808]

carolm1973 ?

This is my question.. did you ask a similar question ?

I was blamed for being a "spammer" when I originally asked this question.

I've been waiting for a response for almost 2 weeks, and have heard nothing.  
I presume it slipped off the radar during the round after round I had to go through with customer support for days on end to prove I wasn't some "spammer".

This is disappointing that it's not been answered.

[sonick808]

Please have a look at my question!

[sonick808]

Thank you for your time. I appreciate the reply.

I was attached to a 12-Lead EKG during 10+ minutes of treadmill stress with my heart rate @ 175 bpm or so, and they said EKG was perfect.  I'm not sure if this qualifies as a "stress EKG", but seems close.

All tests show a healthy heart, just the "99.9% chance of test anomaly" since "stress pictures show perfect, resting pictures had one anomalous picture". "Conflicting result = inconclusive, with a 99% chance of perfectly healthy heart; but let's go ahead and cath anyway".  Cath seems more dangerous than my prospects of cad.

[Douglas Bogart, MD]

Based on this information I think you are correct.