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12182312 tn?1427683956

What testing would be appropriate.

Hi everyone.
I'm going to see a cardiologist for a second opinion on heart symptoms, chest pain, abnormal beats ,etc..my question is, what are the best tests to show blood flow to and from the heart and also for CAD. Coronary artery disease. I had a Cath done in 2015. Are there any other tests?
Thank you..
8 Responses
12182312 tn?1427683956
Also, what are the standard tests for Chest pains.
20794198 tn?1534529493
The usual that are performed would be an echocardiogram ( scan of the heart muscle ), maybe a 24hr ecg tape to record when your asleep and other important times. I think for CAD, its a mix of cholesterol checks, blood pressure checks, and sometimes stress test on a treadmill or bike
20748650 tn?1521032211
Yeah i mean stress testing and echo, particuarly stress echo are useful for identifying cad.. However!

Cardiac catheterization is absolutely the gold standard, theres nothing more definitive then that.. Everything else is sort of indirectly trying to make a "best guess" on where a blockage might be.. In a cath we literally look at your arteries with our own eyes on a live xray system.

Mri and CT angiogram are also useful, providing us with fundementally the same information we get from a cath in most cases.

A "MIBI" nuclear study is pretty darn conclusive too..

Blood work would be a cardiac panel and lipids sure..

Cardiac panel will only identify an acute mi.. A heart attack.. Lipids only tells us how 'at risk' you are.. Little data is provided beyond that.

24 hour monitors are good at finding everything thats not related to cad.
20748650 tn?1521032211
Almost forgot, blood flow to and from the heart..

1. Angiography (cath lab or ir)
2. Echo/ultrasound
3. Mri.. Important point to be made here.. Mri can literally be used to look at whatever the heck you want, as long as the technique, equipment and specialists (key point) are in place... You can assess coronaries, qualify and quantify shunts.. You can scan vasculature, brains, lungs, friggen kidneys.. Anything.. Just about any question you can conceivably have about anything in your body thats larger then a red blood cell can be answered by mri.. The challenge is finding a provider with the know how to make it happen. Mri is no joke.. You can literally take 2 doctors who studied mri their entire careers and perhaps 1 doctor can answer 1 question that the other doctor can not.. And vice versa.. Depending how complicated your case is, you can go down a pretty deep rabbit hole with mri.. But yeah its an option.
12182312 tn?1427683956
Thank you both so very much. You gave me really usefull information. I will being this all up to my cardiologist. Hopefully we can find a diagnosis with these tests and begin treatment.
Do you both work in cardiology?
3 Comments
I do, yes.

That said you never went into,much detail about what youre issue is? You asked about coronaries and blood flow to and from the heart and second opinions..

I gave a pretty large list.. If i knew exactly what im looking for with these tests i could probably point to something more specific.

It would also help to know why exactly you wanted a second opinion and what would,be a preferable treatment option for you? What answer do you WANT to hear and under what conditions would you compromise?
Hi. Thank you for responding. Well for a while now and by that I mean easily over a year, I've been having three symptoms that have been bothering me. One is chest pain. Another is abnormal beats and lastly dizziness. I'm currently going to a cardiologist at a top rated hospital where I live. I've had pretty much every heart test imaginable, except for two. I haven't had a calcium scan or a test for my carotid arteries. I've had echos, monitoring, ekg's, stress testing, a nuclear stress test about two years ago and a cath in 2015. Yet the symptoms persist and my doctor is sending me for a second opinion because honestly they don't know why this is happening. So I'm going to see another cardiologist soon.all I want is to know why I keep getting these symptoms and what is the cause. I just need an actual diagnosis and not "we don't know".  Does another cath sound in order? Any recommendations would be appreciated.
Sorry for all the #39. I don't know why it did that.
20748650 tn?1521032211
I dont think another cath is in order unless you have a positive stress test. I think if you really want an answer, and dont care about risks or costs.. a mri with contrast might be a good plan.

Id also recommend tilt table testing, and another monitor.. 14 day cardiokey is a winner. If all comes back normal then its time to move on to another explanation..

I think if youve already gone through the gambit of cardiac testing it might be a good plan to start moving away from cardiology and in a more neurological direction.
20748650 tn?1521032211
I think if youre negative for cad, differential diagnoses from the cardiac perspective would include.

Prinzmetals angina
Myocardial bridging
POTS
Ectopy/arrhythmia

Tilt table and ambulatory monitor will show the later 2.

Myocardial bridging should be visible with mri, particuarly under dobutamine stress protocol, prinzmetals should be evident from the clinical picture... Its kind of hard to diagnose based off testing.

12182312 tn?1427683956
Thank you so very much
I will being all this up to my doctor. What are the risks of a cardiac MRI?  Also would an MRI show any blockage?
1 Comments
Mri would show blockage.. Especially if contrast is used, it has basically the combined capabilities of a cardiac ct and a nuke study in 1.

It also has the ability to show blood flow/velocity through the chambers of the heart and surrounding vasculature.. In addition to the motion of the walls.. So it does everything an echo does as well.

Theres no risk to the mri machine itsself.. However if you use contrast to observe perfusion theres risks associated with the contrast media..

Specifically kidney failure is a concern.. If you dont have 2 healthy kidneys its gonna be hard for them to keep up.

As i said in previous posts it can also be hard to track down the right facility with the resources and expertise to do a full cardiac mri study.
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