Is there a non-radioactive stress test that can be used to test for cardiac ischemia?

[nosliw]

I've been having palpitations and some feelings of shortness of breath. My cardiologist wants to give me the Thallium-201and Myoview (Technicium 99m Tetrofosmin) intravenous radioactive isotopes for the Nuclear Cardiac Stress test because he said I have "ST changes" on my EKG.  Is there another reliable way to check for cardiac ischemia without using radioactive material in the patient's circulatory system? I am frightened of this test. The intravenous radioactive material goes everywhere in the body, and can cause cancer, not to mention the additional risks of disorders of the heart beat, heart attack, and sudden death.

[erijon]

I certainly understand your fear of the tracer, any exposure is a risk, but your doctor is weighing the risk of the radiation to the risk of your condition and pushing for a Thallium stress test. Based on what the forum doctor said, I would ask your coardiologist why he is wanting the nuclear study as opposed to a stress echo. The nuclear study is better at fiinding blockages in arteries, it's a tough choice. I'm sure he is basing his decision on your symptoms.

Unfortunately, other than a stress echo there really are not any reliable tests for finding blockages, I wish there were and I would have gone that route as well. I'm not a  medical professional, just someone who has been exactly where you are. I opted for the nuclear stress study and it was a load off my mind when I got the results. With it's accuracy rate plus high rate of sensitivity and specificity its a very reliabel test, although no test is perfect.

Good luck with your decision, feel free to reach out to me if I can help.

Jon

[Cleveland Clinic]

Exericse stress echo would be an excellent choice in your case.  There is no risk of radiation exposure.

[nosliw]

Sorry about that, I'm not a savy computer person.

I just read you personal posting, and that you have RA. I'm an RA patient too. By 1999 I had it from the base of my skull to the soles of my feet, and the pain and loss of function made me think I'd be in a nursing home within 2 years!  Nothing I'd tried helped.

Have you ever asked you M.D. about Enbrel?  My rheumatologist started me on it in 1999 and within a month I felt and functioned like I'd never had it! It has given me back my life! But is very very expensive. I pay between $5 -$6 thousand dollars a year for it. (And I have Medicare Plan D, which is a cruel joke.) I don't have much left over for anything else except taxes and food. Enbrel helps 70% of the people who try it. It's also used for Psoriatic arthritis, and juvenile RA.

Sadly, since RA is a systemic inflammatory disease, it attacks all parts of the body, heart and lungs included. They become fibrotic. I've been wondering if it's the RA that's playing havoc with these organs.

Good luck to you.

nosliw

[nosliw]

Thanks for you response. As far as asking my cardiologist about the forum doctor's response...I asked him about my EKG (which he never said anything about after it was taken), and he accused me of arguing with him! He's not a person who will talk to you. The rule of thumb is 15 minutes per patient, and some of the M.D.s stick to that. Things are tough in healthcare, especially for doctors who treat Medicare patients. A few refused me when I told them my main coverage was with Medicare. I do have supplemental, but will tell you, they don't pay much.

What were your symptoms? And did taking the Thallium test result in your getting a treatment to relieve them?

Sorry I was late getting back to the site and to you.  Had a lot to do over the past few days. Thank you again for sharing your experience and thoughts on the subject.

nosliw

[nosliw]

Back in the spring I had an EKG done at a local hospital ER and was told that it is simply an "irritable focus" in a ventrical and was told it was not "life threatening". (But it is disturbing to me and "not normal") The cardiologist I saw recently ordered a lot of blood work done, and my scores were sterling.  Everything was within normal limits.

I still don't want to take the radioactive isotope test. Not because I'm afraid of the procedure, it's the radiation I fear. The effects of the radiation on our bodies is cumulative. Every time we are exposed, the effects of the radiation add up. Each exposure puts you at greater risk for developing cancer. The tech who would be doing the Thallium test in the doctor's office told me the radiation will take one month to be completely cleared from the body. That's a long term exposure. And everyone says it's a small amount of radiation, but every dose adds on to the previous doses. It's a dangerous insult to the body. "First do no harm."

You sound very knowledgeable jon...are you a medical person?  Can you tell me this...Is there no other "non-radiation" test that will show the cardiologist what he's trying  to find out?  I've been looking around and came up with the  Dopler Ultrasonography test that says it enables the examiner to look at the coronary arteries and to see if there is any narrowing or partial blockage.  Why expose a patient to radiation if there are other alternatives? I received a response to my question from an M.D. at The Cleveland Clinic and he said "an Exercise Stress Echo would be an excellent choice in my case", as there is no risk of radiation exposure."  But the cardiologist keeps pushing for the radioactive isotopes. I've gone on too long here. Time to stop.

Thanks for your explanation, and for being so nice.

[erijon]

Anxiety could definately cause palpitations with shortness of breath, very possible. You do need to keep in mind that these could also be a sign if ischemic heart disease. You don't have to have the pain to have this disease. If the doctor is looking for it  I would imagine it is due to these symptoms. The thallium stress test will show areas of reduced blood flow while the stress echo will show areas of wall motion abnormailities which could indicate CAD.

I hope all goes well for you,

Jon

[nosliw]

Thanks for your response and the google tip. I will try that. Do you have the addresses of any of those google sites you could share with me? The echo stress test is the one I want to take.  

I don't have "known ischemic heart disease", that's what the cardiologist says he's trying to find out via the Nuclear Cardiac Stress Test.  Doesn't cardiac ischemia cause chest pain?  I don't have chest pain. Just frequent papitations and shortness of breath (the palpitations make me very anxious.) Could anxiety be causing the "breathiness"?

Best of luck to your wife with the test, and thank you again.

nosliw

[nosliw]

Thank you for your supportive comments and well wishes.

(nosliw)

[erijon]

gman is correct, there is a stress echo but I think which test is reccommended depends on your symptoms and what is being looked for. If your cardiologist is looking for blocked arteries I think the Thallium/Myoview is the way to go. This test will show areas of your heart muscle that are not getting the proper blood flow. I have had this test twice, its no big deal. I don't think there is much risk of cancer from the tracer plus the risk of heart attack, rate disruptions or sudden death (Very rare) is no different than a normal stress test and would be the same as a stress echo.

I'm sure the doctor will give you a better understanding of the risk, but like I said, I've done it twice and it is really not a big deal, you can do it!

Good luck!

Jon

[gman2009]

Yes, it is called a stress echo test.  You can google it and get more data.  It is basically an echocardiogram done before and after the stress test.  

However, my understanding is that if you have known ischemic heart disease that the nuclear stress test is indicated.  

My wife has a stress echo scheduled in a couple of weeks.