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Stress Echo ok, substantial coronary artery blockage still possible ?
Old 09-20-2015, 02:37 PM   #1
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Stress Echo ok, substantial coronary artery blockage still possible ?

Can a stress echo come out just fine, and still have potentially deadly artery blockage hiding ? I know an angiogram is not normally done without the patient being in distress, ( procedure is expensive, painful, and has risk in itself )
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Old 09-20-2015, 03:04 PM   #2
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While no stress test is 100% accurate the nuclear stress test is the most accurate. I assume you did not have this test.

:: Princeton Longevity Center :: -

"The nuclear stress test is generally considered to be the most accurate type of stress test. It has a sensitivity of about 81%, meaning that it will miss about 19% of high-grade blockages. (As noted above, it will miss almost all of the blockages that narrow an artery less than about 65%) It has a specificity of about 90%, meaning that 10% of the abnormal nuclear stress tests will turn out not have a significant blockage."
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Old 09-20-2015, 05:06 PM   #3
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From the above link:

" A Stress-Echo Test uses ultrasound to image the heart after exercise to detect portions of the left ventricle that do not move as well as expected because of lack of blood flow. "
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Old 09-20-2015, 09:13 PM   #4
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Just saw a Netflix documentary called "The Widow Maker". It is not a key part of the documentary, but there are statements within it that claim is that a stress test is very unreliable. The main thurst of the documentary is the suggestion that a coronary artery scan is a simple, quick, inexpensive and reliable test to indicate potential for heart blockage issues. (link below discusses documentary). The end of the documentary suggests this is getting broader acceptance based on recent tests.

I am not a doctor and have little medical knowledge but I had both tests plus a heart cath to look for problems in my mid 40's. The nuclear stress test gave strong indicator of problems. The coronary scan indicated zero potential for problems. The coronary scan results were confirmed by the heart cath.

https://www.yahoo.com/health/could-a...333574532.html
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Old 09-21-2015, 12:17 PM   #5
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It was not the nuclear type test. From what I now understand, artery blockage can be huge with little symptoms, and contrast dye is the only sure way to find out. I'm assuming the medical side would have a huge problem to deal with if everyone with blockage = > 75 % was known. I assume many will live a full life and die of other causes.

A 42 Y.O. co-worker some years back in seeming good shape, not over-weight , but terrible diet . The job can be extremely stressful to some personalty types. He was feeling sick ( this guy rarely called in sick) so went home sick. Never made it, Was on the phone with his wife while driving home. Phone disconnected. He was found in his wrecked car, single vehicle collision into utility pole. Was DOA at the emergency room. Autopsy revealed cause of death was coronary , not trauma from the wreck. Left a wife and 5 children .
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Old 09-21-2015, 12:22 PM   #6
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Originally Posted by Whisper66 View Post
Just saw a Netflix documentary called "The Widow Maker". It is not a key part of the documentary, but there are statements within it that claim is that a stress test is very unreliable. The main thurst of the documentary is the suggestion that a coronary artery scan is a simple, quick, inexpensive and reliable test to indicate potential for heart blockage issues. (link below discusses documentary). The end of the documentary suggests this is getting broader acceptance based on recent tests.

I am not a doctor and have little medical knowledge but I had both tests plus a heart cath to look for problems in my mid 40's. The nuclear stress test gave strong indicator of problems. The coronary scan indicated zero potential for problems. The coronary scan results were confirmed by the heart cath.

https://www.yahoo.com/health/could-a...333574532.html
I've spoken to several cardiologists about this and they think the heart scan is a waste of money. However, these guys don't make any money until AFTER you've had a heart attack so I took it with a grain of salt.
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Old 09-21-2015, 05:22 PM   #7
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I've spoken to several cardiologists about this and they think the heart scan is a waste of money. However, these guys don't make any money until AFTER you've had a heart attack so I took it with a grain of salt.
I had a heart scan some 15 years ago and the results were negative for calcium the marker that's used. I've been considering having another to see where I now stand. My doc started me on Lipitor last winter (cholesterol around 220 and above normal LDL) but took me off it when I developed muscle aches and pains. I figure the heart scan might indicate if I really need to be on lipitor and just put up with the side effects or if I can do without the statins.
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Old 09-21-2015, 05:37 PM   #8
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As far as the calcium heart scan goes, I had one done about 9 years ago. I have been thinking of getting an update but was told it uses two chest X-rays worth of radiation. I can use less radiation in my life not more.

For those of you you have had one recently, do you know if the amount of radiation they use nowadays is less than that 10 years ago?
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Old 09-21-2015, 05:48 PM   #9
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Originally Posted by Lakewood90712 View Post
It was not the nuclear type test. From what I now understand, artery blockage can be huge with little symptoms, and contrast dye is the only sure way to find out. I'm assuming the medical side would have a huge problem to deal with if everyone with blockage = > 75 % was known. I assume many will live a full life and die of other causes.

A 42 Y.O. co-worker some years back in seeming good shape, not over-weight , but terrible diet . The job can be extremely stressful to some personalty types. He was feeling sick ( this guy rarely called in sick) so went home sick. Never made it, Was on the phone with his wife while driving home. Phone disconnected. He was found in his wrecked car, single vehicle collision into utility pole. Was DOA at the emergency room. Autopsy revealed cause of death was coronary , not trauma from the wreck. Left a wife and 5 children .
A 55-year old man I indirectly knew felt tired and told his secretary he was going home early. He never made it home, and it took a few days before they found him dead in his car in a parking lot, where he pulled over and died. I did not know the result of the autopsy, but a heard attack would be most likely. He was a full colonel in the USAF, so would have had regular health checkups.
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Old 09-21-2015, 05:48 PM   #10
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My mother had a non-nuclear stress test done which showed no heart problems (long time smoker, family history of heart disease).

Six weeks later at the age of 62 she had a heart attack that almost killed her.
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Old 09-21-2015, 06:53 PM   #11
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Okay, not a MD. With any diagnostic test you are going to have 4 possible results; TP true positive -- the test is abnormal and the patient has disease, TN true negative -- test is negative and there is no disease, FP false positive -- the test is abnormal and there is no disease and FN false negative -- the test is normal but there is disease. The diagnostic accuracy for a nuclear stress test is 85% to 90%, for stress echo the results are 65% to 80%. A word of caution, the test is only as good as the physician and staff performing the exam.

The real question is what is your risk/likelihood of having a cardiac event; ie, a heart attack or cardiac death and how should you be treated? If you have a strong family history of heart disease, multiple risk factors; sedentary life style, diabetes, overweight, high blood pressure, smoker, high lipids ... you should be seeing a cardiologists. Side note diabetes was listed as a risk factor in the past -- is is now know that diabetic patients have the same risk profile as patient that have already had an MI -- in other words, diabetes is not a risk factor for heart disease -- it is equivalent to having heart disease.

If you've had these tests and you're not comfortable with the physician's finding and his/her care -- it might be time to seek out a second opinion.

Stress testing with nuclear imaging is the diagnostic test with the most evidence based outcomes. The one finding that is accepted is; if the patient completes a treadmill stress test with nuclear imaging and the results are normal -- the likelihood of the patient having an MI or cardiac death is less that 1%, which is less than the general population.
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Old 09-21-2015, 08:38 PM   #12
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Timely info, just completed a nuclear stress test last week. Follow up appt with cardiologist is scheduled for next Monday. Have read the results in my online med file to prep myself for what the discussion will likely cover. Also had the heart catheterization about 20 years ago which was indeterminate.
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Old 09-22-2015, 07:46 AM   #13
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As far as the calcium heart scan goes, I had one done about 9 years ago. I have been thinking of getting an update but was told it uses two chest X-rays worth of radiation. I can use less radiation in my life not more.

For those of you you have had one recently, do you know if the amount of radiation they use nowadays is less than that 10 years ago?
I get a calcium heart scan every year. And yes, much has changed from ten years ago. The amount of radiation depends on the type of scanner. The lowest radiation (approx. 3x less than other scanners) and the highest accuracy (approx. 3x more than other scanners) is with an EBT scanner. Problem is finding one. I think there is only one in Colorado and I'm grateful it's not too far from me. The amount of radiation for a heart scan from an EBT scanner is about the same as that of a mammogram.

There are other scanners that also use less radiation, and certainly I'm not advocating annual scans for everyone. My case I feel justifies it. The important thing is you do have to get scans periodically, otherwise you have no idea if your plaque has stabilized, progressed, or regressed. And it's always best to get tested on the same machine, same clinic, for most accurate comparisons.
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Old 09-26-2015, 06:07 PM   #14
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The angiogram is the gold standard. It also has a 1% probability of serious consequences. All the different "stress tests" have some predictive value but there's no guarantee.
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Old 09-29-2015, 12:16 PM   #15
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Had my followup appt with cardio doc yesterday, seems my analysis of test report was pretty accurate, as in it did not indicate any smoking gun; doc was satisfied that proper precautionary steps (BP and cholesterol under control) were already in place. Thought it was all good and I was home free, but oh wait, time for a listen. "Hmm, did anyone ever mention you have a heart murmur?" So, now I am scheduled for an echo-cardiogram. Reading up on the murmur issue, there are a couple of risk factors/causes that fit my case, guess I'll see where it leads to. At least the doc and I are both on board with less meds are better. Being ER now is making ongoing weight loss easier with exercise and improved diet, so hopefully this can just all be chalked up to an abundance of caution and things improve instead of getting worse.
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Old 09-29-2015, 12:52 PM   #16
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Can a stress echo come out just fine, and still have potentially deadly artery blockage hiding ? I know an angiogram is not normally done without the patient being in distress, ( procedure is expensive, painful, and has risk in itself )
Please refer to my signature line for the use of this reply.

Yes, there are false negative stress echos, probably due to flaws in technique, failure to reach max predicted heart rate, doing the final echo too late after the exercise, inadvertent of beta-blockers etc. IIRC, the false negative is around 10% rate for women and men.

The good news is that if you can achieve a MET level >= 10 this portends a good prognosis even if the study is otherwise abnormal (that is a pretty high level of exertion). Proper interpretation requires assessment by a physician as to risk factors, other health conditions and risk factors.
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Old 10-01-2015, 09:06 AM   #17
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Can a stress echo come out just fine, and still have potentially deadly artery blockage hiding ? I know an angiogram is not normally done without the patient being in distress, ( procedure is expensive, painful, and has risk in itself )
In short, yes. At least according to the research I've seen.

FWIW, I just had a heart catheterization done last week. After dreading it beforehand it was much easier than I thought. They went in through my wrist and it was over in less than 30 minutes. I was cleared and went home two hours later.
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Old 10-01-2015, 09:41 AM   #18
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In short, yes. At least according to the research I've seen.

FWIW, I just had a heart catheterization done last week. After dreading it beforehand it was much easier than I thought. They went in through my wrist and it was over in less than 30 minutes. I was cleared and went home two hours later.
DH had a diagnostic wrist procedure too and it was pretty easy for him too versus using the femoral artery according to his friends. Hope you are well.
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Old 10-01-2015, 09:51 AM   #19
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Just as an FYI, there is NOTHING that can give you a true safe diagnosis....

My BIL had heart problems.... had some procedures done etc... had a pacemaker....

Went to his cardiologist and got a clean bill of health.... died of a heart attack less than a month later.... (btw, he had been going to this doc for many many years, not just once)...
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Old 02-21-2016, 10:18 PM   #20
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Sorry to bump an old thread. Was at the Dr. office recently, I asked about so called "Silent" heart attacks. Was shocked when my Doc told me about 50% of heart attacks fall into that definition.
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