Catheterization Question

[Kenny1948]

I have posted elsewhere here.  I was recently admitted to the hospital with Afib, and subsequently put on medications.  Meteropol Succinate  25 mg ( just reduced to 1/2 tab ), and Flecainide 50mg twice daily along with 20mg Simivastatin and 325mg of aspirin.

I took a Adenisone/Thallium stress test a few weeks ago, along with wearing a holter monitor for 24 hours.  The Holter came back normal.  However the stress test revealed some ischemia to one lower part of my heart.  The doctor suggested I have a catheterization,but since I do not have health insurance ( dropped by Humana ) he said we could wait and see how I do on the medication alone. And that I should look into trying to find some sort of medical insurance that would pay for it.  I have had no chest pain, nor had any shortness of breath.  I walk about three miles every morning, with no ill effects.  Likewise I have returned to my normal routine, without any either.  Some occaisonal dizziness is all.  That, I have attributed to the medication.

What I am curious about is this.  Is such an invasive procedure as catheterization really called for. Without any symptoms?  If I really felt it was necessary, I would sacrifice my savings to have it done.  However, everything I read, says this does not necessarily prolong your life, or guarantee anything.  

I don't know what to do.  This doctor is connected with a local HCA hospital here in Bayonet Point Florida.   They specialize in heart related procedures but are a "for profit" facility.  I am concerned that they may be suggesting procedures simply to make money.  

I appreciate comments.

[ed34]

thank goodness I live in the UK and get to use the National Health Service. I know certain
countries politicians gave some quotes regarding this on the news recently but as a whole it is a very good service. I can choose which hospital I attend and which experts
I am referred to. The only fault is the administration, the government have installed 'managers' into hospitals to control costs but of course they use most of it on
expenses. If they gave the responsibility of running the hospitals to the doctors, it would
be far superior.

[kenkeith]

Older and diabetics individals are at risk for a silent ischemia, but the probability is very low and doctors and insurance companies rely on probabilities. A cardiologist needs to account for any interventational procedure or any therapy to insurance and that includes a notation of angina (chest pain, or history) at the very least for expensive testing procedures and possibly less expensive procedures!  Needless, to say if that were not a necessary component as well as guidelines by AHA and AAC, there would be chaos in the medical community regarding treatment...that should be obvious with individualism notwithstanding.  

I have stated may times I had  silent  ischemia that resulted in heart failure and I'm well aware of the situation, but....  However, now, whenever there are follow up procedures and tests the doctor includes angina in all reports even though I don't experience any chest pains.

[ed34]

It's important to note that not everyone feels symptoms of damage being done to the
heart. As an example, I knew nothing of the total blockage at the top of my LAD and
it has been there for years, unknowingly to me. I was fortunate that new vessels grew
across from the circumflex to feed into it. However, when a clot formed in my
circumflex the situation became very drastic and I was lucky to survive. The cardiologist
in your case obviously feels your arteries warrant further investigation and it is just the
problem with insurance that has made him hope medication will suffice for now. The
thallium test has revealed that a section of your heart is not receiving enough oxygen
and unknowingly to you, this could cause damage if left. The cardiologist wants to be
sure that everything is ok and to be honest I can see his point of view. The bottom line
is if you feel ok, it doesn't mean everything is fine. Some people have heart attacks
and feel nothing, they are shocked to be told their troponin level is very high.

[kenkeith]

Without symptoms, there should be no need to submit to an interventional procedure.  All treatment options treat symptoms only, not coronary artery disease itself. Follow a regimen to reduce your risk for CAD as your doctor suggests and you will be OK.  What you have read is not inconsistent with reality and substantiated with scientific studies..

[ed34]

Catheter based solutions or PCI is not really invasive, it is as uninvasive as you can get
regarding treating the heart apart from medicatioin.
Some people have fairly large blockages in Coronary arteries and don't seem to notice
anything is wrong, while others will be gasping for air and suffering chest pains.
You may not notice any problems at the moment, but the nuclear scan is showing a
problem where a portion of your heart is suffocating. If left alone, the restriction in the
blood vessel supplying this area will worsen and the cells will die, never to regenerate
again. If I was in your shoes, I would strongly consider having this treatment done.
If you leave it, and heart tissue dies, your heart will not function as well as it should do and believe me, you will look back wishing you'd had this done.