should I get a angiogram?

[singularity]

hey all,

  For the last 10, 15 yeas of my life I have experienced chest pains, numbness of the left side of the body, nausea, gastrointestinal problems, severe fatigue etc. They have done many EKGs, stress testings but found nothing. My doctors are reluctant to do a Angiogram due to the risk. They feel that it is not likely for me to have a heart issue since if I did I probably wouldn't survived for so long.

  But for me, all my symptoms points towards a heart problem. I can't do anything physical for too long without feeling fatigued and I have constant chest discomfort. I think Angiogram is the only way to know for sure so I want to convince them to let me have one. Any suggestions?

  Thanks!

[kenkeith]

I don't see your point to repeat the same question at different threads on the subject.  It may be that you are confused, but you have said the same thing on another post.  If you are not successfully treated with your present therapy, find another doctor, not rely on members' experiences to make up your mind.  

[oldie]

Eight months ago I had a dubotamine stress test which showed weakness at three points in the heart walls ‘suggesting’ CAD, ‘probably’ trivascular.  The doctors said I should get catheterization.  Now, the forums have convinced me I must do it. I had chosen the medication, diet exercise route. I feel the same as before – good days and bad hours.
The postings that decided me were those that said that without an angio one cannot know to what extent the arteries are blocked and that meanwhile they would be getting worse. If anyone approves or disagrees please say so.

[ed34]

Stenting isn't always repeatedly performed, you are probably looking at the cases where they unfortunately have problems. This is always the thing with the internet, it seems to always bring up the worse case scenarios rather than the millions of successes.
The key thing is to first establish any risk factors for heart disease and remove them from your life. Such things as smoking, lack of exercise, bad diet, high stress levels etc. All these things plus others contribute to heart disease and are something which we can all do something about. IF it turns out to be a hereditary factor which no other lifestyle changes seem to affect, then this is rare. In the majority of cases, just stopping smoking or eating healthily makes huge changes. If people make no changes, then of course the disease will continue to form and require more intervention. It's a bit like being told you have damaged knee joints and you need to rest for several weeks, but you go jogging every night. Personally I believe bypass surgery will eventually become a thing of the past. I also believe stenting of the coronary arteries will too. For years now they have been researching into growing artificial artery frames which will withstand the pressure of blood inside them. They are coated with stem cells and these grow a brand new artery. So, your current diseased artery is physically removed, the synthetic framework is put in its place and coated with stem cells. In a few weeks you grow a new artery and the frame work dissolves. I think, judging from research, this will be available in the next decade. Research is also investigating growing new valves for transplantation. Now stem cells are more understood and we can eliminate the problems of rejection, the sky is the limit.  

[arindambanerji]

I was wondering if angioplasty is better or bypass surgery. i have read in a few forums that angioplasty has to be done repeatedly even if a sten is used during it. Dont you think that it worsens the situation of the patient.

Any suggestions?

My mom will be going through an angiogram today, when i spoke to the nurse and the doc they said that there isnt any risk involved in it. I am not sure what they meant.

[singularity]

CT (64 slice) Scan came up with nothing. Now what? If this is not a heart problem, what other areas I should look into?

[kenkeith]

QUESTION: "My echo showed critical aortic stenosis. The doctor refused to do a scheduled Nuclear exercise test because it was too risky, has an angio that now shows only mild non-surgical aortic stenosis but did show coronary artery disease which be taken care of with stenting and angioplasty. No now my doctor recommended a TEE to actually see the valve. So here I am wondering if I can get the stenting, will I need bypass or bypass and aortic valve replacement.  Has anyone had this predicament".
_____________________________________
A TEE provides a better view expecially if there is interference with a thoracic echo such as overweight, etc.  An echo with the doppler software should have given ample information regarding the blood flow through the aorta valve, however, there may be details missing in your post that justifies a TEE.  I can tell you from my experience, if there is going to be a valve replacement, and there are occluded vessels with substantial blockage (greater than 70%), there would probably be a bypass at the time of valve surgery.

You may want to get a second opinion. Your situation is somewhat complex.

[kenkeith]

Quiote: I don't think this place is for expressing ones opinions about political systems. The important thing is there are brilliant minds who will come up with breakthroughs no matter who finances their research !

_________________________________________
No one has expressed an opinion or degradation of any political system socialized or not.  The heart forum is the appropriate community to discuss any advancement of heart treatment.  Frankly, your criticism is unwarranted and somewhat personal.  No need to judge and try to analyze someone's motivation for asking a heart related question!

[conniebird]

My echo showed critical aortic stenosis. The doctor refused to do a scheduled Nuclear exercise test because it was too risky, has an angio that now shows only mild non-surgical aortic stenosis but did show coronary artery disease which be taken care of with stenting and angioplasty. No now my doctor recommended a TEE to actually see the valve. So here I am wondering if I can get the stenting, will I need bypass or bypass and aortic valve replacement.  Has anyone had this predicament.

[anandbharti]

Socialized or not, initial research is done in University labs. For example, In vitro fertilization was developed in UK by a team of  physician Dr. Steptoe and biologist,  Dr Edwards. Dr. Edwards was a Cambridge University researcher wheras Dr. Steptoe was a gynaecologist.

A number of inventions which concern us heart patients were developed by scientists who worked in countries with socialized medicines. These include the inventors of beta-blocker, MRI, CAT scan and angioplasty

I don't think this place is for expressing ones opinions about political systems. The important thing is there are brilliant minds who will come up with breakthroughs no matter who finances their research !
.

[ed34]

"A new heart without paraphernalia may not be very helpful"

http://www.youtube.com/watch?v=j9hEFUpTVPA

I think you will find this interesting, it is a bit old now and the research has since come forward a lot more. The technique for turning our own stem cells into heart cells has been perfected for example. This research is in the USA.

The bacteria growing new synthetic blood vessels I believe is being done in Sweden.

[kenkeith]

To: kenkeith I spend a lot of time looking at new technologies. Did you know that synthetic vessels are being grown using bacteria now? they produce a cellulose based vessel which is not very prone to clotting. Trials have also begun with injecting stem cells into the coronary arteries, stem cells specifically recoded to produce blood vessels in the hope the hearts will be revascularised. I know clinics have been claiming this ability for a while, but no improvement has been actually proved. I can't wait to see the results from this trial. The scientists managed to grow new vessels in mice and it's hoped the technique will work just as well in humans.
The main research I'm following with great interest is the growing of a new patients heart in a lab using their own stem cells. Working hearts for mice and rabbits have been grown fully functional, but this research seems to be slowing down. I think their main concern is ensuring a modified stem cell won't suddenly turn rogue, becoming cancerous. However, I think in the next few years, we will see the first human trials.
How fantastic will that be, no longer waiting for donor hearts and no more rejection problems. 70 year olds having the heart of a young adult put into them, I wonder how much fitter they will feel from this. Of course, there are all the other arteries in the body stiffening from age :(
_______________________________________________


That is interesting, I haven't read anything regarding the research and development you refer.  Is the R & D being done in the UK?   If so how is the work being financed?  May be some of us do not have a good understanding of socialized medical care.  It is my understanding government is not very efficient and it hinders and slows progress.

A new heart without paraphernalia may not be very helpful.

[erijon]

Your insurance may very well decide not to pay. The only way they will is if your doctor recommends one, and as stated earlier most will not without a good medical reason. Reassurance is not valid in the eyes of most insurance companies or cardiologists.

[ed34]

I think it depends on the area of the body they wish to take images of. Usually to obtain clear pictures of arteries, a dye will be used. If for example they require pictures of the bowel, then a special radiactive dye is given in a drink form. It depends on what's being scanned.

[singularity]

what's the difference between a CT scan with dye and without dye?

[singularity]

My doctor says BCBS might not pay for the CT scan? Is that true? Usually how much do they cost?

Thanks!

[anandbharti]

This is the sequence of tests I had in last few months. I had a nuclear stess test conducted by my cardiologist. He thought my heart wall showed abnormality so he asked me to get a a CT angiogram. CT angiogram is a noninvasive process and in a nutshell, a 360 x-ray picture of your heart. The only danger is the radiation and the dye they inject in you to visualize the organ. Well, the CT angiogram said the wall was OK but there was significant blockage in the LAD coronary artery. The blocking was  confirmed using a "traditional" angiogram or catheterization and I had a stent put in to fix that.

So my advice is to get a CT scan done and take it from there.

You have my best wishes

[ed34]

I spend a lot of time looking at new technologies. Did you know that synthetic vessels are being grown using bacteria now? they produce a cellulose based vessel which is not very prone to clotting. Trials have also begun with injecting stem cells into the coronary arteries, stem cells specifically recoded to produce blood vessels in the hope the hearts will be revascularised. I know clinics have been claiming this ability for a while, but no improvement has been actually proved. I can't wait to see the results from this trial. The scientists managed to grow new vessels in mice and it's hoped the technique will work just as well in humans.
The main research I'm following with great interest is the growing of a new patients heart in a lab using their own stem cells. Working hearts for mice and rabbits have been grown fully functional, but this research seems to be slowing down. I think their main concern is ensuring a modified stem cell won't suddenly turn rogue, becoming cancerous. However, I think in the next few years, we will see the first human trials.
How fantastic will that be, no longer waiting for donor hearts and no more rejection problems. 70 year olds having the heart of a young adult put into them, I wonder how much fitter they will feel from this. Of course, there are all the other arteries in the body stiffening from age :(

[kenkeith]

Thanks, I wasn't aware of the 320!:)

There appears to be two as of a year ago...the new 320 slice CT is only located in two places in the United States: Brigham and Women's Hospital in Boston and Johns Hopkins Hospital in Baltimore

The new scanner can produce 320 -- or an even more detailed 640 -- cross-sectional images or slices. Then, a computer stacks up the slices to create 3-D pictures. Doctors can better see subtle changes in blood flow or blockages forming in tiny blood vessels in organs, with amazing detail and accuracy.

The one second scan exposes patients to less radiation and allows more patients to receive the scan. DeFord's heart scan is being used as a guide to help speed up his life. "I'm hoping to get my life back," he says. Now, getting it back can take just seconds.

[ed34]

"ct scan 256 slice"

Is nobody using the new 320 slice scanners yet?

[singularity]

Thank you for your support here guys. Very very helpful!

[joanincarolina]

The non-invasive approachs should be tried first.A heart cath does carry risk and is NOT diagnostic for all heart problems.I know that first hand.I would suggest you head to a well known Heart Center for evaluation.You may not get an answer, but you'll find out what 'its' not.Because the doctors say you would not have survived if it was something with your heart is incorrect; if you read many entries here you know that there are not always answers and many of us are managing heart problems and have been for years, not all times in those years 'quality' times. Don't dismiss your signs.Joan.

[erijon]

Lest you think the risk is low enough to ignore, let me tell you what happened to my Mother. I've told this story here before, about 4 years ago she went to the ER with chest pain that she wanted to get checked out. She had some abnormal activity on her EKG so they sent her to the cath lab. As soon as the cath entered her heart it went into v fib and she was just minutes from death. It took 9 shocks to get her rhythm back. Having said that, I would have one tomorrow if my doctor said I needed one but I would never volunteer for one until it was necessary. 1 - 3% risk of complication may not be much but it's 1 -3% higher than none.

I would certainly opt for a safer and less invasive procedure until it was necessary. As I said, a Nuclear Stress Tests has a specificity of 97% meaning that it will find CAD in an individual who has blocked arteries 97% of the time. I would also explore a CT Angiogram before I started letting a doctor thread a catheter up my leg into my heart.

Just my opinion, good luck on your decision.

Jon

[kenkeith]

Singularity, there is another option: The ct scan 256 slice is able to provide a reliable angiogram with very little risk of exposure.  It is more inclusive as it also provides images of the pulmonary system and the descending aorta.  Some people have an aneurysm of the descending aorta and don't know until there is a rupture that is often fatal.  

My ct scan showed atectasis (scarring) of the left lower lobe.  I know I abused my pulmonary system for years and the result is unexpected and no surprise.  Doesn't cause any symptoms...

[ed34]

Personally singularity, I think you are wise. We all get fed up having test after test and still not knowing what the problem is.