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Worry, CT Scan or not?
I am 55. About a month ago, I went to ER for a panic attack while walking. Because my troponin level was .05 (normal at this hospital was .035), I was admitted. During the night the troponin level was .452. EKG was always normal, no trouble breathing or other symptoms or lab findings. At the hospital the cardiologist recommended an angiogram or nuclear stress test. The nuclear test showed the following results:
"The estimated left ventricular ejection fraction is about 60% which is normal. There is suggestion of mild left ventricular chamber dilatation with Persantine stress, in particular, with a TID inde of 1.15. This is a nonspecific finding and may or may not reflect some underlying multivessel coronary artery disease. There is no significant regional wall motion abnormality identified. There is question of incomplete myocardial wall thickening in basal portion of the inferior wall on the cine study. Slightly decreased tracer uptake at the cardiac apex and small portion of the anteroseptal wall is identified on the Persantine stress study. It is probably related to apical thinning and soft tissue annenuation artifact. There is also decreased perfusion or tracer uptake in the basal segment of the inferior wall on the persantine stress study, with improved perfusion in this area on the resting study. Normally, it would raise the possibility of small amount of myocardial ischemia in this area. However, given its location, elevation of the right hemidiaphragm, this may be an artifact related to diaphragmatic attenuation. Hence, clinical correlation is advised."
The cardiologist wasn't that concerned and prescribed standard medications. This happened out of town. With a cardiologist back home he is suggesting the 64-slice CT scan. He says it could reassure me since we both agree my anxiety is out of proportion. But I worry now that having another test could open the door to more worries (and procedures) that may or may not be justified.
"The estimated left ventricular ejection fraction is about 60% which is normal. There is suggestion of mild left ventricular chamber dilatation with Persantine stress, in particular, with a TID inde of 1.15. This is a nonspecific finding and may or may not reflect some underlying multivessel coronary artery disease. There is no significant regional wall motion abnormality identified. There is question of incomplete myocardial wall thickening in basal portion of the inferior wall on the cine study. Slightly decreased tracer uptake at the cardiac apex and small portion of the anteroseptal wall is identified on the Persantine stress study. It is probably related to apical thinning and soft tissue annenuation artifact. There is also decreased perfusion or tracer uptake in the basal segment of the inferior wall on the persantine stress study, with improved perfusion in this area on the resting study. Normally, it would raise the possibility of small amount of myocardial ischemia in this area. However, given its location, elevation of the right hemidiaphragm, this may be an artifact related to diaphragmatic attenuation. Hence, clinical correlation is advised."
The cardiologist wasn't that concerned and prescribed standard medications. This happened out of town. With a cardiologist back home he is suggesting the 64-slice CT scan. He says it could reassure me since we both agree my anxiety is out of proportion. But I worry now that having another test could open the door to more worries (and procedures) that may or may not be justified.
MEDICAL PROFESSIONAL
Hello
The interpretation of the nuclear stress test is relatively straightforward and the cardiologist after examining you and monitoring you in the hospital with EKGs and lab work and felt comfortable sending you home. Most decisions regarding the need for further testing are made based upon you current symptoms and complaints. that is, if you do not have what is considered to be unstable angina (chest pain, shortness of breath at rest or progressive with exertion), there is no evidence that a procedure such as angioplasty or stent work any better than the best medical therapies that medicine can provide
The bottom line is that many physicians practice a very defensive form of medicine for various reasons these days. It is up to the patient to ask their doctor is the test really necessary and why. And what way does the information change the course of treatment
I suspect if you proceed in this way with your doctor, he may not want to perform the CT scan. If he does then so be it.
I would suggest that you take this opportunity to motivate yourself to change those things that can decrease your heart attack and stroke risks like dietary restriction to improve cholesterol and activity to improve body weight. Good luck
The interpretation of the nuclear stress test is relatively straightforward and the cardiologist after examining you and monitoring you in the hospital with EKGs and lab work and felt comfortable sending you home. Most decisions regarding the need for further testing are made based upon you current symptoms and complaints. that is, if you do not have what is considered to be unstable angina (chest pain, shortness of breath at rest or progressive with exertion), there is no evidence that a procedure such as angioplasty or stent work any better than the best medical therapies that medicine can provide
The bottom line is that many physicians practice a very defensive form of medicine for various reasons these days. It is up to the patient to ask their doctor is the test really necessary and why. And what way does the information change the course of treatment
I suspect if you proceed in this way with your doctor, he may not want to perform the CT scan. If he does then so be it.
I would suggest that you take this opportunity to motivate yourself to change those things that can decrease your heart attack and stroke risks like dietary restriction to improve cholesterol and activity to improve body weight. Good luck
MEDICAL PROFESSIONAL
Good luck. Im glad that youve felt better. Finally, don't forget that stress management and the optimistic mindset contribute to a healthy lifestyle as well. www.personalwellnesswheel.com
Dr. Kirksey,
Thank you for your response. I appreciate your take on the nuclear stress test results as "straightforward." I think the new cardiologist considers it as not definitive enough, which could be for the defensive reasons you mention. By the way, since my hospitalization, I haven't had other symptoms except the anxiety I described and some fatigue, which is probably related to the beta-blocker I'm taking.
I do appreciate what you have to say about using this event as motivation to lose weight and cholesterol. That is what I'm doing. I will also talk to my doctor again about the necessity of the test. Thank you again.
Thank you for your response. I appreciate your take on the nuclear stress test results as "straightforward." I think the new cardiologist considers it as not definitive enough, which could be for the defensive reasons you mention. By the way, since my hospitalization, I haven't had other symptoms except the anxiety I described and some fatigue, which is probably related to the beta-blocker I'm taking.
I do appreciate what you have to say about using this event as motivation to lose weight and cholesterol. That is what I'm doing. I will also talk to my doctor again about the necessity of the test. Thank you again.
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