Also, what are the standard tests for Chest pains.
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
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.
Almost forgot, blood flow to and from the heart..
1. Angiography (cath lab or ir)
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.
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?
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.
I think if youre negative for cad, differential diagnoses from the cardiac perspective would include.
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.
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?