Stress Test, Do they really work?

[Annie110663]

I am 48 yo male.   I have had 2 heart attacks and 7 stents with the last heart attack being 6 months ago.  Nothing was done except revive me and determin that i did in fact have a heart attack.  I would have thought they would have done a heart cath at that time but they didnt.  They referred me to my Cardiologist and he ran a stress test, not the tredmill but the other one.   This was done about 3 months ago was told nothing showed up.  Went back to cardiologist last week and explained to him the chest pain i was having constantly daily and having to use Nitro Spray.  Last week i underwent a heart cath.  Expecting a few minor blockages, not 100%, 85%, 75% and 30% in a stent.  Now I am set for open heart surgery next week.  HOW IN THE WORLD COULD THIS HAVE GOTTEN MISSED?  I would have thought at least the 100% would have showed up.  I am wondering now if the results were even looked at.  Info and opinions welcome.  I am still in shock...............Thanks

[Flycaster305]

I suspect that the insurance company felt that  a heart cath wasn't needed.  An angiogram is generally performed within 30 minutes of an indication of a heart attack.
That being said, stress over 'Why' is not an issue, you are going to have a big surgery and worrying about the 'Why' at this stage is counter-productive.  How can those of us who have experienced bypass surgery help you?  

[ChatterAlly]

I am surprised they didn't take you to the cath lab when admitted for the heart attack. I have had at least 3 heart attacks now and I was whisked off to the cath lab in a hurry each time. I am confused as to why this hospital chose not to follow that standard?  Wow. I am sorry for that. But not sure it would have made any difference in the blockages.

[erijon]

That's the same thing my Cardio says.

[ed34]

Yes I agree, the gold standard is the angiogram, but it's the risks associated with it. It can't be used as a routine screening tool. I think this is why the CT angiograms are being pushed more now, especially as the resolution is much higher. I keep asking my cardiologist why he doesn't use them, he simply says "you can't see all the vessels clear enough".

[Bamajoe]

I had one that was the opposite of you. I had a nuclear stress test on the treadmill that showed a blockage and then when they did the cath the next day I had no blockage. Unfortunately for me 6 months later they found a tumor inside my heart and I had to have open heart to remove it. I would say that the best test is the cath especailly if you are having chest pains/SOB ect. I am not a doctor but I have had a couple of them tell me that the stress test is only about 70% accurate. That is close to being wrong 1/3 of the time. Not a good number when you are talking about the heart IMO.

[ed34]

In addition, a stress echo is only as good as the technician looking at your heart. If he/she misses something, then it will not be seen by the cardiologist or anyone else in the hospital unless the test is repeated and perhaps spotted the next time around. Human error / misinterpretation is a huge part in most things in life. My echo/nuclear scan/ECG all revealed perfect perfusion. If I hadn't had the Angiogram first, then I would have been sent home being told I had a perfect heart. However, I had several blockages which were known, 100%, 98%, lots of 30-50%.
Some people also seem to have symptoms such as throat discomfort, chest pains, shortness of breath etc before any tests reveal anything which in many cases makes the Doctors disregard the heart. I've had bad angina before and my troponin blood test was negative. The Doctor in the ER was going to send me home, but luckily my Cardiologist walked past and noticed me. He said he would admit me to the Cardiac unit. The following day he did a Cath and there was a 98% blockage.

[erijon]

Sorry to hear of your issues. A stress test without nuclear perfusion is approx 65% accurate, with nuclear perfusion it is about 85% accurate. Yes, these tests can miss heart disease.

As far as your hospital experience, it is not uncommon to skip a cath if you had to be revived. Your heart was in a weakened state and may not be able to handle the additional stress of a cath.That was the case with my mother, they went ahead with the cath and she had to be shocked 9 times to be revived and it was the result of the cath after her heart attack.

I wish you the best, good luck.

Jon