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Old 04-17-2015, 08:13 AM   #1
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Medical question

Just got home from cardiologist office; I went to primary dr with shortness of breathe a couple of weeks ago.

Test and results:

3 EKGs, Normal
2 Echo Cardiograms, Normal on one, excellent of second one
1 Pulmonary test, normal
blood test, normal cholesterol at 157
LDL 96
HDL 34

Nuclear Stress test, indicates previous heart attack, coronary artery disease and maybe a blockage, pictures not 100% clear.

Dr wants do a Angiogram and has put me on a statin and Imdur.

How can all the test prior to the Nuclear stress test be normal and still have issues and not know you had a heart attack in the past, and do I do the Angiogram?
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Old 04-17-2015, 08:22 AM   #2
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How can your car appear to operate normally at idle, but acts up when going uphill on the highway?

Same thing. The stress test is showing issues. The good news is the MI was probably very limited, hence it doesn't show on the resting EKG.

If I were you, I'd have the angio done.
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Old 04-17-2015, 08:42 AM   #3
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Thanks JoeWras, one other question than, one of the EKGs was done while doing the stress test on the treadmill and it was normal, should that one have shown an issue under stress? Also, blood pressure has always been good and was good during stress test, pulse good, and O2 stats good.
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Old 04-17-2015, 08:50 AM   #4
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Don't know all the tests you had, but look at what they are testing.

EKG - measures electrical signals that control the heart.
blood test... cholesterol ... usually tested for to indicate a potential contributor for HD.. not an indicator of problem level.

EC... never had one... don't know about it.
Pulmonary test.... same as above.

Nuclear ST... never had one, but looked it up. It is meant to see blood flow in resting and excited states. This gave them a different view.

-----------
I went to the hospital a few years ago with a couple of very short lived light headed spells and short blackouts over a 5 day period. did a bunch of tests in the ER and then admitted me for tests. nothing conclusive in the ER. I blew way the stress test and the cardio group was ready to send me home. Got my (brain) MRI last for neurology.. but too late in the day, so they kept me over night. I had several light headed spells... no alarms on the EKG. They went back through the data and found an intermittent problem, periodically no signals on the bottom of the heart.... I left the hospital with a pacemaker.

Short answer... not all tests catch all things. In my case... I don't know why the wireless EKG would not alarm on missing signals on the bottom of the heart. But it may have been a setting to not over alarm for leads that disconnect or intermittent issues.

Be glad they have a much better idea now.
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Old 04-17-2015, 10:21 AM   #5
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Originally Posted by DFA View Post

Dr wants do a Angiogram and has put me on a statin and Imdur.

How can all the test prior to the Nuclear stress test be normal and still have issues and not know you had a heart attack in the past, and do I do the Angiogram?
I've had all those tests sans-serif Angiogram, multiple times all normal. The last cardiologist wanted to do the Angiogram too. I asked why? Well you said you may have had Rheumatic fever at age 9. True memory, but no murmur or any other issues.

When I started asking why and what would you do about any findings, that stopped the Angiogram discussion. Maybe I'm the foolish one; but seems like if you order a test you might have a plan for all the results. Or billing was slow that month.




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Old 04-17-2015, 10:32 AM   #6
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An angio for rheumatic fever is weird. Echo, sure. Angio, really? However, shortness of breath, and failed nuclear ST are pretty good indications to go forward with an angio.

There are too many out there, I know. My doc doesn't believe in angios for everything. However, he specifically said that the above sequence would probably call for one.
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Old 04-17-2015, 10:34 AM   #7
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BTW, I'm not a doctor in any way shape or form. My advice is probably worthless.

To the OP, you could get a second profession opinion too.
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Old 04-17-2015, 10:39 AM   #8
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I'm not a doctor either (thank goodness).

I tend to think that you should go with what your doctor is saying, and maybe get a consulting opinion or even switch doctors if/since you obviously don't trust him to know what he is doing.

The last thing I'd do is rely on what people say about it on a forum.
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Old 04-17-2015, 10:44 AM   #9
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I'm not a doctor either (thank goodness).

I tend to think that you should go with what your doctor is saying, and maybe get a consulting opinion or even switch doctors if/since you obviously don't trust him to know what he is doing.

The last thing I'd do is rely on what people say about it on a forum.
+1

Your cardiologist trained for over a decade to obtain the expertise to answer your questions, and is mandated to do continuing education to stay current. Use his/her expertise, or get a second qualified opinion.
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Old 04-17-2015, 10:47 AM   #10
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+1

Your cardiologist trained for over a decade to obtain the expertise to answer your questions, and is mandated to do continuing education to stay current. Use his/her expertise, or get a second qualified opinion.
Agree. Cardio sees thousands of cases and knows the typical outcomes.

Personally, a shortness of breath episode along with something suspicious on a blood flow test would have me DEMANDING an angio, and damn fast too. Too many people get little warnings like this an ignore them.
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Old 04-17-2015, 12:38 PM   #11
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Yes, you do the angiogram.
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Old 04-17-2015, 01:57 PM   #12
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Quote:
Originally Posted by DFA View Post
Just got home from cardiologist office; I went to primary dr with shortness of breathe a couple of weeks ago.

Test and results:

3 EKGs, Normal
2 Echo Cardiograms, Normal on one, excellent of second one
1 Pulmonary test, normal
blood test, normal cholesterol at 157
LDL 96
HDL 34

Nuclear Stress test, indicates previous heart attack, coronary artery disease and maybe a blockage, pictures not 100% clear.

Dr wants do a Angiogram and has put me on a statin and Imdur.

How can all the test prior to the Nuclear stress test be normal and still have issues and not know you had a heart attack in the past, and do I do the Angiogram?
A normal stress echo which reaches 10 METS (reflecting a vigorous level of exercise intensity) suggests a very low risk of heart attack for at least 5 years despite other usual risk. There are exceptions (e.g. pulmonary diseases) and is mostly applicable for coronary disease.

Before agreeing to an angiogram consider asking your cardiologist two simple questions: what would be done if the test is abnormal and what would we do if it were positive. If the reply is essentially the same (with or without the angiogram) it may be reasonable to get a second cardiology opinion, perhaps who is not an noninvasive specialist.

This is general information which may not apply to individual cases. Best of luck and let us know how things turned out.
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Old 04-17-2015, 03:26 PM   #13
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Don't mess around with potential heart issues. Get whatever tests they recommend. I know this from personal experience

I had a heart murmur and mitral valve regurgitation. I had no symptoms or problems and was very physically fit. It was only when I went in for a stress test the doctor saw how bad the problem was and immediately recommended a mitral valve repair. I had the surgery two months later and avoided congestive heart failure. I was 41. Now, 10 years later, my heart is great and I don't even require meds.

I'm glad they caught it early. Do not mess around with heart issues!

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Old 04-17-2015, 03:36 PM   #14
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I went though a similar series of events last July. I called my primary doc because of the onset of shortness of breath I noticed when mowing the lawn. I'd not had that a week before. EKG was normal and at rest I had zero symptoms.

He admitted me to the hospital that day, stress test the next day. Angiogram and two overlapping stents the day after that. Released from hospital the day after that! The blockage was a 90% blockage of the LAD, also known as the "widow maker". As I understand it when that is fully blocked your life expectancy is measured in single-digit hours.

So I'm kinda glad I took his advice....
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Old 04-17-2015, 05:02 PM   #15
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No recommendations here, just want to wish DFA all the best.

I've just had an echo cardiogram, 48 hour ekg portable monitoring and a nuclear stress test. I get the results in a couple of weeks.
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Old 04-17-2015, 06:03 PM   #16
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I'm not a doctor either (thank goodness).
I hope the doctors here understand, that my "thank goodness" was not meant to be derogatory. At the time, I was thinking of the long hours of hard work that doctors commonly devote to their profession. I am just thankful that I can relax and enjoy retirement now as I am growing older.

Just had to clarify since the meaning didn't seem very well communicated when I re-read it.
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Old 04-17-2015, 06:28 PM   #17
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I hope the doctors here understand, that my "thank goodness" was not meant to be derogatory. At the time, I was thinking of the long hours of hard work that doctors commonly devote to their profession. I am just thankful that I can relax and enjoy retirement now as I am growing older.

Just had to clarify since the meaning didn't seem very well communicated when I re-read it.
No offense taken, W2R. I'm glad I'm not a doctor anymore, too! 😀
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Old 04-17-2015, 06:51 PM   #18
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No offense taken, W2R. I'm glad I'm not a doctor anymore, too! 😀
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Old 04-17-2015, 07:03 PM   #19
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Of course individual decisions are between you and your doctor. Don't be afraid to ask questions about why an angiogram (or any test) is really needed.
Most tests are decently accurate, but unfortunately not 100%. Here's a cardiologist's overview of stress testing I found on web search-
Related Forms & Information | Providence Oregon
Hope things turn out well for you!
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Old 04-17-2015, 07:16 PM   #20
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No advice...
Just a few experiences:

Circa winter 1970, 2AM, 20 degrees F. all alone, 14 miles from Greenfield MA home, in southern Vermont, on a snowmobile on the side of a steep mountain trail... Slid off the trail, down the steep slope, and into the middle of a tree blowdown. An hour of wrestling a 300 lb machine over logs, branches and ice.... overcome and passed out cold for how long Big chest pain. Came to, pushed the Ski Doo back up to the trail, and back home... Never told a soul about it at the time.

!997, coming back from Daytona Beach to central FL, driving with best friend and our wives... sun in the face, after four hours of surfing... Passed out driving @60 mph... my buddy steered the car to a stop. This time... tests, MRI stress tests, holter harness etc,etc... oh boy... "you must have had a heart attack at one time"... hmm "Not that I can remember" big lie.

2005... Dr. detected the old heart attack and suggested stress test... Regular test with treadmill... they almost killed me... pushed and pushed and pushed and couldn't get the BP up to where they wanted... Finally gave up after about ten minutes... I was pooped, and sitting down to catch my breath. Dr. said all was ok... no problem... I was fine... and as he and the aides were walking out the door, the chest thingy started with a lound horn scary sound, and they all rushed back in to look at the print out... Dr. looked at the big spike on the printed read out and said... "Just an anomoly."

Ten years later, never pain nor breathlessness nor any exhaustion associated with heart problems. Never think about it... except for once in a while remembering that dark cold night, in the depths of hell, and no one would have found me 'til spring. Before the days of cell phones.

Alls well that ends well... 45 years since, and feelin' pretty good. Wish you all the same kind of good luck.
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