Stress test question

[KLB32]

How accurate are stress tests in women?  I have heard they are less accurate than in men.  When you get a supposedly normal one, how do you accept that it's normal if the test throws a high number of false negatives?

I had a nuclear stress test two months ago and it was considered normal.  I still have palps, weird chest sensations, arm pain from time to time, shortness of breath (also have asthma).  My chiropractor says that it's from my horrible back(nerves being compressed).  I want to believe him.  Really I do but it's hard when you keep having symptoms and that little voice in your head keeps telling you "what if."

[KLB32]

It is scary how close the symptoms of heart problems and panic/anxiety feel.  

While my total cholesterol was bit high (215) my HDL was at a good level and my triglycerides were 120.  I have really watched my sat. fat intake over the course of the past year so I hope it has come down.  I really need to be retested.

I realize the likelihood of my symptoms being caused by CAD are low but it scares me nonetheless.

I think I have some dysfunction of the nervous system because I have alot of wacky symptoms that just don't make any sense.  I can feel great one day and crappy the next.

[Jack54]

KLB32, this has been over 4 years ago, so keep this in mind, I can't, lol.

My symptoms were crushing chest pain. That is how they describe it, but I had no pain. It was like someone was sitting on my chest. At other times my chest was extremely tight, inside and out. I couldn't relax it.

I have had my share of anxiety and that is really what I and my cardiologist thought it was. I have hyperlipidemia and my total C was >400 and triglycerides were >2000 at that time, so I was worried about that, ergo I requested a stress test. I had been taking a beta blocker (atenolol) for 9 months prior to the mi for fast heart rate and high BP. I had a ridiculous, unimaginable amount of stress from my job.

I must say that my mi was caused by my ramus artery, fairly small, going fully closed. Some people do not have this artery. I have a left dominant heart.

Tony, so sorry you had to pay for the test, but the outcome was worth it. Especially when you compare the risk of catheterization to the risk of contrast dye....I have had 9 cardiac caths. They do not scare me at all now. I have so many tiny scars in that area that they really have to hunt for an insertion site.

The CC had a method of sealing the artery that was "stitch enhanced", or something like that. It was beautiful, really. The best recovery I have ever had. Did you realize that all of the doctors that work for the CC  ONLY work for the hospital? This blew my mind...(small puff for that) They do not have private practices.

Dr. Krasuski told me that they get a salary. Still, there are so many heart patients in this hospital that unless you are dying.....it is hard to get to see them. They make their rounds and the nurses will not disturb them. That might be a good thing, but when you want to get checked out to catch a flight to Bammyland, it raises your BP, lol.

[va_tony]

I also recently had a 64 slice coronary CT-A after a nuclear stress test. The images it produced were fantastic and showed 3 small (<30%) blockages and, unfortunately, lots of calcium in the coronary arteries in general (CAC score of 739). This tes/diagnostic is far more convenient than a catheter angiogram.  As you mentioned, insurance is an issue and I had to cough up the $995 cost of the CT-A myself.

[KLB32]

You said you had a "normal" stress test 3 months prior to having a MI.  What lead you to have the test?  Were you having symptoms?  What were they like and how long did you have them before you had the MI?

I have been interested in the CT Scan ever since it first came onto the market.  I'm sure insurance issues prevent many people from getting it which is really sad.

BTW....I am a 32 year old female in good health and no heart disease in my immediate family so I am told my risk is low.  

[Jack54]

I had a really state of the art nuclear imaged stress test that said my heart was fine, 3 months before I had a heart attack.

If a woman has a large bosom, it can really interfere with the test. If a man has a large gut it can also interfere with the test.

I have had 5 or 6 nuclear stress test over the past 5 years and about half have been right. (1/2 of 5=?)

I had one 3 months ago that showed lack of blood flow to the bottom of my heart, which is a known fact. It didn't show the re-stenosed stent that almost caused me the big one 7 weeks ago.

So, I don't have any faith whatsoever in these tests. Even the best equipment can be improperly calibrated (nuclear cameras, EKG equip., radioactive dye etc) and a tech like one I had today that performs poorly, can skew these test results. Some equipment is outdated but medicare and medical insurance still pay the hospital or clinic the same amount of money as they do for the good, up to date equipment. Some doctors are nobrainers.

Do you know what we call a medical school graduate that had the lowest class grade average? Doctor... :)

You can still have very accurate "non-invasive" coronary imaging if you can find the latest and greatest coronary imaging MRI, or the latest 64 slice coronary artery imaging CT Scan. I had the latter and it was 100% correct as shown by a cardiac catheterization within 3 days of the CT scan. The CT scan gives the victim a fairly high dose of ionizing radiation. The MRI just has a super powerful magnetic field which they are not real sure of what it does to it's victims, lol.

I have had 9 cardiac catheterizations in a little over 4 years. These deals radiate the victim also.....Best of luck to you.

[va_tony]

"Women tend to release greater amounts of catecholamines during exercise than men, which is thought to potentiate coronary vasoconstriction and augment the incidence of false-positive test results (21). However, women have a low false-negative rate in exercise stress testing, which suggests that routine testing reliably rules out CAD in women with negative results (22). Because studies have reported a high prevalence of false-positive ST-segment depression in women, a common concern is whether this group should undergo standard ECG stress testing alone or should always undergo stress testing with echocardiography or nuclear imaging (3). "

from

http://www.postgradmed.com/issues/2004/06_04/tak.htm

"The sensitivity of exercise echocardiography and exercise thallium testing for CAD in patients with one-, two-, or three-vessel disease was also similar (58%, 86%, and 94% versus 61%, 86%, and 94%, respectively). "

[KLB32]

Thank you.  I had a Myoview stress test with a scan before and after the exercise portion and have heard it is more accurate than the standard exercise test.

The thing I worry about is that I've read women can have small vessel disease and it doesn't always show up on the tests.