Stress Echo with enhancement?

[maria694]

I recently went to the ER with chest pains, shortness of breath and a racing heart. Basically, any exertion would cause my heart to race. They did cardiac enzymes, EKG and a stress echo, also a CT scan for pulmonary emboli...everything normal. They did not do the stress echo with enhancement. How important is this? I did not even realize this test could be performed with contrast dye. The doctor said perhaps a heart cath was the next stp OR increasing my Toprol XL dosage. Wouldn't a coronary artery problem at least show a blip or something wrong on the stress echo?  Thank you

[maria694]

I am 54 with no history of heart disease, a perfectly normal lipid panel, normal weight, a vegetarian. I go to the gym 3x/week, do tai chi and walk 5 miles day.. Even though I am over 35, I believe the likelyhood of CAD is very low. Is an event monitor an invasive procedure?

[Darcy Green Conaway, MD]

To begin with, if you are female and below the age of 35 your pretest likelihood of CAD is extremely low even with chest pain typical for CAD. It seems to me like you have had an extensive work-up. Regarding stress echo-- it is not necessary to use contrast to get a good quality study. In fact, most centers do not use it.
Before considering an invasive procedure such as a cath , consider an event monitor to evaluate your palpitations. The most likely cause is premature beats that you can feel. As long as your heart is healthy they do not have a bad prognostic implication.