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Re: Fatal Heart Attack during Stress Test

Posted By CCF CARDIO MD - MTR on August 28, 1998 at 16:13:30:

In Reply to: Fatal Heart Attack during Stress Test posted by Sue on August 27, 1998 at 20:30:22:

My 55 year old brother-in-law recently died whilst undergoing a stress test.
He had, over the past 2 years been taking medication for high colesterol
and high blood pressure.  His frequent visits to his doctor indicated
that both problems were well under control.  
During a recent bout of flu he experienced mild chest pains (similar to
those he had had 12 months ago but had been diagnosed as 'nothing to
worry about').  The doctor, to be on the safe side, referred him to a
cardiologist who ordered a stress test to be followed one week later with
an ultrasound.  He was taken off all medication 48 hours prior to the
stress test.  The autopsy showed that he had extensive heart disease,
three arteries were 95% blocked and his heart was significantly enlarged -
none of which had been noted by any of the numerous doctors who had seen him
in the months prior to his death.
As my husband is about to have a similar test, I am concerned that the
test may result in a simular outcome.  His history is very similar to
that of my brother-in-law.  Is it normal to have the stress without
prior investigation into possible underlying problems?  What should we
do to ensure that he does not suffer the same fate as my brother-in-law?
Thank you.

test without initial investigation?  

Dear Sue, thank you for your question.  I can understand your concern about your husband undergoing a stress test with the knowledge that your brother-in-law died during this procedure.  Stress tests are safe procedures because most high-risk patients can be screened out before the test to undergo cardiac catheterization. At the Cleveland Clinic, we do thousands of stress tests per year and our mortality rate is 1 in 10,000 tests. Our patient population is sicker than the average patients who undergo stress tests because we have many sick patients referred to our institution for a second opinion.  Unfortunately, your brother-in-law had no symptoms to indicate he had such severe coronary artery disease to alert his physicians prior to the stress test.  Stress tests are often the first test performed in patients suspected of having coronary artery disease because the symptoms are often vague and other invasive tests have a higher risk profile.  Thus, stress tests are used to screen patients with a low to moderate suspicion of coronary disease.  If the stress test is positive or if the patient has definite clinical evidence of coronary disease (i.e. ECG, evidence of myocardial damage on blood tests, or clear, definitive symptoms of angina), a stress test is bypassed and cardiac catheterization is performed.  If your husband has a similar risk profile as your brother-in-law, then you should speak with his physician and express your concerns.  However, as I mentioned earlier, your husband would not be at increased risk from a stress test because your brother-in-law died during his stress test.  Finally, it is common practice to discontinue cardiac medications 1-2 days prior to a stress test to improve the diagnostic accuracy of the test.  I hope you find this information useful.
Information provided in the heart forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your physician.

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