what tests stress echo cardiac CTA?

[philby937]

I am 33 years old i have been having symptoms of lightheaded-ness,  painful palpitations, new exercise intolerance,   getting breathless walking up stairs, atypical heavy chest pain,  attacks of breathlessness/nausea and even worse lightheadedness.    

I was seen in the ER and got a chest xray,  labs and a resting echo which were all normal.

I have been reading things online and was wondering..

I want to 100% rule out a cardiac and pulmonary problem,  Is it reasonable to go see a cardiologist and ask for a stress echo and cardiac CTA?   Do doctors hate it when people go request specific tests?     Would these 2 tests 100% rule out a cardiac and/ or pulmonary cause, if normal?         what else should i get done  if you don't think these are good tests?

[bigkev414]

Hi mate-- I'm 64, and have had problems since taking Sudafed for sinusitis about 15 years ago. Diagnosis is SVT's which are 'quote - life affecting and distressing but not dangerous unless my heart races for long periods' unquote.
No sign of cardio vascular disease, and was told that I will NEVER find out WHY I get the arrythmia and to take beta blockers which I now do every day. A 1/4 of the prescribed dose otherwise I just want to lay down and sleep.
I am a big fella, 6'2" and 18 stone (in the 'real' money) and am very unfit which I know. The cardiologist is a tiny Englishman who 'tut tuts' me about my weight and fitness, but otherwise tells me to take the medication and try not to stress. OK for him, he doesnt even get hungry and often forgets to eat! I know that long periods of upset like ongoing family rows etc can eventually bring my attacks on.
I am coming to terms with this gradually and think we can only try to accept that we have problems and are getting older but everytime I see somebody in a wheelchair with oxygen mask on I think I'm not so badly off.
Take it easy. Regards Kev. (PS I'm on a balanced diet at the moment - equal amounts of chocolate ice cream and  potato wedges with sour cream)

[Cleveland Clinic]

First I want to let you know that no single test or group of tests are 100% certain in excluding presence of any disease. Test and the people who read them are simply not perfect. Now at 33 years of age, unless you have extensive family history of premature CAD or familial hypercholesterolemia or other disorders of lipid metabolism ( which would have manifested by you having extremely elevated LDL and total cholesterol levels) you have very very low probability of having obstructive CAD. I cannot comment on the probability of pulmonary disease and the best way to exclude this as I do not know your risk factors for venous thromboembolism, or parenchymal lung disease.
I suspect that you would benefit from a Holter monitor as a way to figure out the cause of your palpitations. But with a normal echocardiogram this is unlikely to be the cause of your exercise intolerance.

[big_fred]

kev,  how old are you and did you ever find your diagnosis?

[bigkev414]

I did the same thing with the same symptoms and contacted the visiting ( Hospital Emerg centre) cardiologist and he got very annoyed and told me that HE would decide what tests I needed. You are right, they do think we are cabbages. I went to my local GP and asked him to refer me for a stress ECG to put my mind at ease and he did. I went and had one on the treadmill and
had to stop after 6 minutes because of my arthritis and I was puffing and blowing like a steam engine but the ECG was Ok. Apparently they are only about 60% - 80% indicative of pulminary disease / problems but will induce exercise triggered arrythmias and they can then 'catch' the palpitations on the ECG and see what kind they are. I didn't want to bother doing it but I'm glad I did. It didn't take long and was just like going for a walk.
I don't know where you live but in Australia where I am there are heart assessment clinics run by GP's who only do cardiac assessments with the latest computerised equipment and you don't need to visit an actual specialist cardiologist to have the tests. Maybe you could find out about that?
good luck, lets know how you get on.