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Stress test vs CAT angiogram

Sitting at airport, laptap in lap, on phone talking business.  No particular stress or activity.  Suddenly felt constriction in middle of chest to the left, like constricting a squash ball.  It became tighter then moved to middle of chest, caused sweating at hairline and then slowly dissipated.  After much hesitation informed airline who called paramedics who took blood pressure ang EKG.  Blood pressure 150/90 and nothing abnormal on EKG.  Went to family physician who was concerned and suggested nuclear stress test or CAT angiogram and gave me a choice.  He ruled out blood work to look for enzymes.  He told me the CAT would require prior insurance approval and recommended nuclear stress test.  Like the EKG's I am sure that nothing will show up on the stress test.  Should I save the insurance co pays etc and go straight to CAT angiogram?

This discussion is related to Nuclear stress test vs angiogram.
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367994 tn?1304953593

Myocardial perfusion scan. During this procedure, you exercise on a treadmill or pedal a stationary bicycle. When you reach your maximum heart rate, you're given the injection. Images are made of your heart shortly after exercise and also a few hours later. This test shows how well blood flows into the heart muscle and can detect narrowing of the coronary arteries (coronary artery disease). Appropriate for vessel occlusions...ischemia that may cause angina (chest pain).

I recently had a CT angiogram (64 slice), and my insurance paid without prior approval.  My insurance is correlated to medicare coverage and having prior heart issues may be a consideration.

A cardiologist may order the test to get a clear picture of the heart, the aorta (the main artery carrying oxygen-rich blood from the heart to the rest of the body), the lungs and the coronary arteries. My lungs showed slight abnormalities in the right and left lobes (probably from smoking years ago!).

The main difference between the two tests is that the ct angioplasty shows the anatomy of the entire vessel (not just the lumen).  It would show any remodeling of the vessel, and that would show up when there is soft plaque between the inner lining of the vessel and the outer layer.  It allows physicians to look more closely at intricate heart structures.

You have chest pain:  The CT angiogram have also been used in the diagnosis of abdominal aortic aneurysms. embolism, thrombosis with increased accuracy in identifying the site, nature and extent of blockages. The chest or thoracic CAT scan can give clear pictures of the heart and lungs. Damage to, or disease in, the heart, which could be a sign of many different cardiac problems. The CAT scan may also reveal signs of chronic obstructive pulmonary disease.

The ct angiogram provides a calcium score of the 4 main arteries individually and a total score.  The score is a numerical value calculated by the number of pixels in each slice (differentiates by density), and the score provides an evaluation the degree and the seriousness of any calcium buildup and the probabity of a future heart event.
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