Cateterization

[bnpublisher]

I'm a 68 year old male with heart disease in the family. I would like to know more about the condition of my heart than what is revealed through my stress EKG. Why can I get my cardiologist to order up a heart cat. for me on my request? ....... Should simply find a new cardiologist that will?

[ed34]

I think a CT Angio using dye is far better than the calcium score. This scan has missed too many patients. They've kind of fudged a chart to try and make it more accurate but still a considerable number of patients slip through the net. The problem is it scores how much calcium there is in the arteries, not the soft gooey stuff which clogs the arteries and kills most people. Patients who haven't formed a cap over the goo have a great calcium score and those with thin caps but a huge amount of goo trapped underneath have a relatively low score.

[itdood]

You might also consider a CT or MRI.  CT can do something called a coronary calcium scan, in some instances they can detect problems even before a cath can see it.   I had a cardiac MRI because it was thought that I had a muscular disease called ARVD.  The cardiac MRI also performed a 3d flow and imaging of my coronary arteries which came up with a 0 calcium score and excellent flow.  My father had a massive MI on his LAD when he was 42 so I also have strong family history.  But you must know that there are a great many other heart disease processes that can kill you other than blockages.  By the time you get to a cath they pretty much suspect you'll need a stent too.  

[ed34]

I don't believe it is about liability. If you was a cardiologist and you agreed to Cath someone for nothing more than peace of mind, and they died during the procedure or became seriously handicapped through a stroke, would you believe you had made the right decision? Doctors obviously have feelings too and each intervention that goes wrong must play on their minds. There are other procedures which are far less risky than an angiogram because they are not invasive. For example, nuclear thallium scan or the good old CT Angio. If you are in fear of having heart disease, the standard stress test should highlight any serious problems and you don't even need a scan with that.

[bnpublisher]

Interesting, 15 years ago, my Dr. Friend I, each of us with a family history discussed ordering up caths for each of us. We did nothing about it. Nine months later he was dead at 48 years of age! On the other hand my sister-in-law has had two caths ordered. She has been told that she has the arteries of a 20 year old. She is in her late 50's.

It looks to me like a matter of liability/risk, the doctors or the patient. With all the liability papers we sign these days as patients, is there a paper that we can sign that puts the risk squarely on the patient, leaving the doctor free of risk?

[Occupant]

Based on the information that you have given hear and what your cardiologist said it would certainly not be an "informed decision" to go ahead with the Angiogram.

[bnpublisher]

Peace of mind says it best. My Dad was gone at 70....heart. I have maintained good fitness, but engage in stressful activity, manual labor, ice hockey, backcountry skiing, hunting and hiking in the mountain west.

I would like to weigh the risk of the cath against the risks that I take in an uncontrolled environment in my daily activity and personally make an informed decision and not have it made for me.

[itdood]

If I knew more details I might be able to point you in the right direction.

Why do you want more tests?  Are you looking for peace of mind or are you trying to address symptoms?  what are the symptoms?

What is the heart disease that runs in your family?  Is it clogged arteries, arrhythmia, enlargement, high BP, dysplasia, regurge...?

[ed34]

Because if there is no sign of ischemia through stress, then they will not authorize a risk associated procedure. If there is no sign of ischemia I'm sure you wouldn't want to risk a heart attack or stroke through having a cath?