Event monitor while on meds?

[Moony37]

I finally saw a cardio yesterday and really didn't like him for many reasons, the biggest of which was the apparent inability to put a coherent sentence together most of the time, another was not answering my direct questions with direct answers, and a third was brushing off my answers to his questions and then being incorrect in talking about what was going on.  At one point he stated/asked, "So, you're having breakthroughs on your meds?"  I told him no, I wasn't, I was feeling a very rare odd beat and hadn't had any tachy in three weeks, two weeks after going to 100 mg Toprol.  I was there about chest pain and lightheadedness/dizziness.  I won't be going back to him, also based on the following.  

I had a Cardiolite test done on Tuesday that shows "borderline moderate ischemia" which the doctor doesn't believe-he thinks it's artifact and just doesn't believe it's possible for me to have CAD.  It took 12:29 to get to 160 bpm, topped out at 169 and BP stayed good the entire time (only raising after I hit 90 bpm the end).  So off I go for a stress echo next Tuesday to confirm the Cardiolite findings but he also wants a 30-day monitoring done.  What's the point of having a 30-day monitoring done if a) a Holter has all ready caught all of my rhythm problems and b) I'm on meds that are controlling my rhythm problems well?  What is he going to catch on an event monitor that has anything to do with chest pain that's not related to a rhythm problem?  I just don't see the point in putting off a (possible) definitive diagnosis for an additional five weeks if the interim tests are worthless.      

[ireneo]

They don't make it easy for us, do they? I hope you get some answers soon. Take care of yourself. Have fun with the monitor (yeah, right :-)

[Moony37]

Sorry for the confusion.  Yes, "he" is the doc I don't like and "she" is the other cardio that I hope I'll like.  The cardiolite test uses a radioactive tracer to measure uptake of oxygen in the heart walls after both rest and exercise, and a stress echo looks at heart wall motion after rest and exercise.  At this point I'm hoping something pops up on the monitor right away and I don't have to do it the whole month.  Today I had some bad symptoms that brought me home from work early, second day in a row.  Different ones, too, so along with taking the monitor on Wednesday I'm going to try to get into the other cardio right away to get clarification and talk about today's symptoms.  Thanks so much.    

[ireneo]

OK, I think I've got it figured out. The "him" is the grumpy cardio and the "her" is the better one. I don't know the differences between the stress echo and the cardiolite test so I can't say whether getting the stress echo will be worthwhile. I suppose if the cardio's order the test, then they must be looking for something.

I'd go for the event monitor because all kinds of things can pop up during a month's time that won't happen during the 24 hour Holter.

If you're more comfortable and confident in the other cardio, the second opinion and you aren't experiencing life threatening symptoms (fainting, can't breathe, long lasting chest pain) then I'd go with that one even if it means delaying things a week or two. That's what I did. They called me, said I was scheduled to see Dr. Grumpy Pants for my pre-surgical visit. I asked if I could see Dr. S instead and they gave me that even though it was going to be a week later (still pre-surgical though). I need someone I can talk to and trust that he's listening to me. Ultimately it's your decision.

[Moony37]

Yep, that's what I want to know too.  So do I do the stress echo and then see the other cardio right afterward to get some clarification on the Holter and her feelings on the event monitor, or do I do the stress echo and monitor and see the other cardio in a month?  No way I'm going back to the cardio I saw Wednesday.  I'm just wondering if it would be worth getting the second opinion, as there'll be at least a week's lapse time between the stress echo and getting in to see the cardio again.  I suppose the other cardio might want the event monitor even if the stress echo shows the same as the Cardiolite.

[ireneo]

"The results said that my abnormal rhythms and beats coordinated with the symptoms I recorded but no mention of what was going on at the time of the chest pain."

Sorry for being so dense here but the abnormal rhythms coincide with your symptoms. That's one thing. But was the chest pain separate from the abnormal rhythms? I think it would be good to pin the doctor down, find out exactly what "abnormal" rhythms you are having and ask what was seen on the monitor during the chest pain episodes. If s/he isn't willing to share the information, I personally would get another cardio. My very first cardio was a grump, got impatient with my questions. So I switched. It all makes perfect sense to them but we need to know more.

[Moony37]

Yes, I had chest pain during the Cardiolite and also some pressure once my rate went over 120 bpm.   I had an episode of chest pain while I was on the Holter, too.  The results said that my abnormal rhythms and beats coordinated with the symptoms I recorded but no mention of what was going on at the time of the chest pain.  I have chest pain most of the time nowadays (maybe an hour or so between "episodes" that last for a few hours more), usually pain scale 1-2.  Monday I had stabbing pain in my chest followed by constant pain of about a 3-4 with dizziness/lightheadedness so I went to the ER.  Would it behoove me to talk to another cardio before I accept the monitor, or should I just do it anyway?  If I wasn't so shaky with this doctor overall I'd just go with it, but I don't quite trust him fully after being unclear about what the problem actually is.

[ireneo]

When you did the Cardiolite and the Holter, did you have chest pains then? If not, then they didn't catch that. I'm going through the same thing. I do have tachy times and ectopics but ignore them. What they wanted to see was my times of chest pain. The day I wore the Holter, my heart was relatively quiet. Same with the stress test. I just finished up with the 30 event monitor. Yes, I did record some chest pain episodes. Now I wait for the results.

I believe they can see times of ischemia on the recording. Perhaps there are blockages or vasospasms causing the pain that are unrelated to your arrhythmias. Be patient and I hope you get answers soon.