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Alternative to Angiogram?

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Heart patients are given a number of different tests and some have questions whether the most invasive of these, the cardiac catheterization (a.k.a. angiogram) is necessary. Post these questions here. (More information about these tests can be found in Angioplasty.Org's "Imaging and Diagnosis Center".)

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Current Postings on This Page (66):

• I would rather have these 4 screenings (Carotid Artery, Heart Rhythm, Abdominal Aortic Aneurysm, & Peripheral Arterial Disease) than an Angiogram. I think the information these non-invasive screenings provide is very important, and necessary. Additionally, will lead to a better result.
Kate-Alexa, California, September 9, 2022

• Ron88 - Cardiac CT is a great tool. It is 99% accurate as a "rule-out" test. In other words if the CT shows no blockages, then there probably are none. If the Cardiac CT shows a visual blockage, it may or may not be significant (i.e. is causing ischemia, or reduced blood flow to the heart). There is currently a test, called FFRct which can process the CT image to show whether or not the blockage is significant. We posted an article about it when it was approved by the FDA, back in 2014. No further involvement from you is necessary because it uses the CT data that's already been generated. If, for any reason, you are concerned about a false positive and you wind up getting the angiogram, definitely discuss your concerns with the cardiologist who will be doing the angiogram. Ask if he/she will use FFR or iFR during the angiogram to determine whether the blockage is ischemia-producing. If not, current best practice is not to place a stent. One question: you report having no symptoms and no problems surfaced by a stress echo, so why did you get a CT in the first place? Did you have some concerns or reasons to think you might have a blockage? There is much controversy in the field of cardiology about the "oculo-stenotic reflex": if you see a blockage, then you must stent it. A number of randomized clinical trials have shown that, unless the blockage (stenosis) is ischemia-producing, there is little reason to implant a stent.
Angioplasty.Org Staff, Angioplasty.Org, October 9, 2018

• Hi - I'm about to go next week for an invasive angiogram. I had a CT scan that showed a possible significant blockage in my LAD. I have no symptoms, and passed both a stress and a stress echo with flying colors. I run slightly high cholesterol and am allergic to statins although looking at PSK right now. I am very scared to have the angiogram, as I worry that I might get a stent that isn't needed and also side effects/complications of the angio. Two other cardiologists said don't go, the third says I can't take a chance on a false vs real positive. Help!
Ron88, Waltham, MA, USA, October 7, 2018

• Terry - You've asked an important question, one that is somewhat controversial in the cardiology community. A Cardiac CT Angiogram (CCTA) and nuclear stress test measure two different aspects of potential coronary artery disease (CAD). The CCTA is visual: it shows if there is a narrowed artery, a blockage, and also shows the anatomic characteristics of the patient's coronary circulation (curves of the vessels, etc.). CCTA is a great test to rule out CAD. If the CCTA shows no blockages, then there is no CAD. However, if there is a high likelihood of coronary artery disease, then the CCTA may not be the best test because it won't add much information. The question is that, if a blockage is seen, is it significant? Does it reduce blood flow/oxygen? Currently, CCTAs don't show this information. You may see a blockage, but it may not be having any major effect. What's needed is physiologic testing: a nuclear perfusion stress test can show if the heart is being deprived of oxygen. We're not sure why a nuclear perfusion test is necessary to examine T-wave abnormalities, and why a standard stress test wouldn't suffice. These are questions you should ask your cardiologist. It's very possible that she has good answers, but you certainly should be able to discuss this issue with her. Also be aware that a thallium stress test carries a significant radiation burden, 15 mSv or more. Low-dose protocol CCTA can be done at 4 mSv or less.
Angioplasty.Org Staff, Angioplasty.Org, February 25, 2015

• My cardiologist wants to do a thallium stress test because of an episode of right sided chest pain after exercise. I requested going straight for a CT angiogram instead and she said she wanted to do the stress test first because of a "T-wave " abnormality on her EKG. This is old and showed up in ekg's years ago, and i had an echo confirming some left ventricular enlargement. Why would she want the stress test over the CT on that basis?
Terry, South Carolina, USA, February 25, 2015

• Cheryl4747 in Milwaukee -- A CT Angiogram might show whether or not you have blockages in your coronary arteries. It's a non-invasive test that has 99% negative predictability -- that is to say, if the CT Angiogram shows no disease, then you have no disease and there is no reason to move to an invasive angiogram. Stress tests, while a valuable tool, can often show false positives. Ask your doctor about the advisibility of a non-invasive CT Angiogram. Also make sure that, if you get one, you go to a center that practices low-dose reduction protocols so the radiation you are exposed to is minimized. For more info, visit our Imaging and Diagnosis Center.
Angioplasty.Org Staff, Angioplasty.Org, July 3, 2012

• I am a 61 yr. old female that leads an extremely stressful life! after being under extreme stress for one month I went to my Dr. with a fluttering feeling. He said probably stress gave me some pills and did an ECG. Looked good with something showing on the bottom of my heart possibly old. Went for an echo-stress test just to be safe. Echo at rest was perfect, stress treadmill perfect. Heart rate went to 169, had no pain or any negative symptoms at all, just out of breath and weak legs. Dr. said everything looked fine. BP went where expected during and after. Received a call from Dr. office stating an abnormal stress echo. Abnormalities showed up on the back of my heart. This I was told means blockages and I would need a catheterization next. I feel fine BP has been 108/65 pulse 72 all weekend. The test went fine except for the stress echo. Would a CT be just as good? I am terrified of any invasive procedure. My Dr. said when it's the back of the heart there aren't any symptoms so I could have a silent heart attack. Is this true? With all of the tests and how I am feeling being so good should I agree to a catheterization? I would hate to die from an unnecessary test if another would do the job.
Cheryl4747, Milwaukee, Wisconsin, USA, June 24, 2012

• My husband had a stroke 4 months ago, now doctors want him to have a chemical stress test. The medicine rises heart rate, scares me to think he may have another stoke. Is there another test to see if he has stopped up arteries.
Donna, Georgia, USA, May 31, 2012

• Praveen in Dubai -- read our Patient Guide to Heart Tests.
Angioplasty.Org Staff, Angioplasty.Org, May 26, 2012

• how do doctors detect a heart disease? What are the various treatments available for heart disease?
praveen, Dubai, May 20, 2012

• Maya in Nashville -- Have you discussed alternatives with her cardiologist, such as a CT Angiogram? This could show if there are any blockages and where they are, without the invasiveness of an standard angiogram. Nuclear stress tests are not as accurate as a CT angiogram -- although it sounds like your mother does have a blockage. The question is whether to treat that blockage is dangerous or whether her symptoms can be treated with medications. If an angioplasty and stent seems likely, then perhaps she should go straight to the invasive angiogram, with the possibility of a stent/angioplasty done during the same procedure. In any case, this is a conversation she should have with her cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, October 10, 2011

• My mother is 59 years old, overweight, and has had increasing chest and jaw pain, dizziness and fatigue over the last year. Her recent nuclear stress test showed a blockage in the back of the heart, according to the cardiologist. Her other tests show: cardio CRP is 4.7 (ideal is below 1), triglycerides 116 (ideal is below 100), homocysteine cardiovascular 8.6 (ideal is below 8), and Blood Glucose 105 (Ideal: 60-85. Pre-diabetic: 95-110. Diabetic: Above 110). The cardiologist has recommended "an arterial angiogram," but my mother is terrified of such an invasive procedure and its risks. I know there are some testing alternatives, but are there treatment alternatives for which it is not too late? Thank you!
Maya, Nashville, Tennessee, USA, October 6, 2011

• Wife in Delaware -- What is the specific reason that your husband's cardiologist wants to do the angiogram? Have there been any new symptoms or results in other tests? Angiograms are not a "routine" test, since they are invasive. Have you discussed alternatives, such as a CT Angiogram.
Angioplasty.Org Staff, Angioplasty.Org, July 15, 2011

• My husband has had angioplasty several times since 1991 when he was 39. He had bypass in 1995. In 2001 he was having a heart attack when they put stent in him. I 2005, during angioplasty he had a cardiac arrest and was revived. He had another bypass in 2005. He did not come to senses for over 10days. After that I was told by the doctor that he might need heart transplant. We did not go for it. He has been doing fairly well so far with medication. Now his cardiologist wants to do the routine test of angiography. Should he really go through this? I am scared.
Wife, Newark, Delaware, USA, July 12, 2011

• Claret in Canada -- OK. So you got a Cardiac CT Angiogram. This test is very accurate in eliminating coronary artery disease (CAD) as a possibility, somewhat less so in showing the extent of narrowing, especially when there is a significant amount of calcified plaque (calcium is opaque to the CT and tends to obscure the view of the arterial blockage). The COURAGE Trial showed that it is safe to defer intervention (stents, etc.) for patients with stable angina who are getting Optimal Medical Therapy (meds, exercise, smoking cessation, diet, etc.). But if the angina progresses, angioplasty is always an option for symptom relief. If it gets to that point, we'd recommend reading our information on Fractional Flow Reserve, as well, since not all blockages, seen as significant on angiography, need stenting. Good luck, and let the Forum know how you make out tomorrow.
Angioplasty.Org Staff, Angioplasty.Org, April 28, 2011

• Sorry I should have been more specific, I've been feeling angina like pain in my left arm when exercising although it never showed up on a standard stress test. They then sent me for an angiographic CT Scan (minimally invasive by injecting into an arm vein). They did not give me any score and when I asked how badly it was blocked he just told me it was significant. I do see my GP tomorrow and I've created a list of questions that I'd like to have answered as outlined in my previous post.
Claret, Canada, April 28, 2011

• Claret in Canada -- You didn't say what diagnostic test this picture was from. Was it a coronary calcium scan (CSC)? If so, this test only shows calcium deposits in the arteries. Was there a number score given to you? A CSC can be a measure of risk, but it does not actually show blockages. The plaque in the artery causing a blockage is made up of different types of tissue, etc. These plaques often have calcium associated with them. Having a high calcium score means you're more at risk and that you should do everything you can to bring risk factors under control (meds, exercise, diet, smoking cessation, etc.). An actual Cardiac CT Angiogram, which is done non-invasively with an IV contrast injection, can more clearly show blockages. An actual invasive angiogram, done in the cath lab, is the most accurate, especially when intravascular imaging measures, such as IVUS or FFR are used. One potential downside to all this early testing is if it leads to unnecessary interventions or unnecessary anxiety. The best course is to discuss the findings with your cardiologist and get help from him/her or elsewhere in risk modification.
Angioplasty.Org Staff, Angioplasty.Org, April 28, 2011

• I received the news I had been dreading, as I knew that the picture the technician was looking at was mine and her comment of "WOW" perked up my ears. I have major calcification of the coronary arteries. At this point they tell me the risks associated with either angioplasty or bypass outweighed the risk associated of leaving things as they are. How can this be? Do I actually have to have a heart attack before something is done? I'm not on any statins as I form an allergic reactions to them, including muscle weakness. I was just told that if my condition changed then to call the cardiologist back. What defines major and significant calcification?
Claret, Canada, April 28, 2011

• Claret -- we would assume the opposite. If there had been a problem, the doctor might have wanted to explore further. But it's hard to say. Did you ask the doctor why he stopped? It may be that he in fact did get a good image and there was no reason to expose you to more radiation than was necessary. Please let us know what you find out.
Angioplasty.Org Staff, Angioplasty.Org, March 23, 2011

• Today I had a CT Angio and the prescribed procedure was to have 5 passes through. The first two without dye and the last 3 with increasing amts of dye. After the third pass the procedure was stopped as the Dr. said he had all he required, and I was up and told to go home. Why would they not have completed the five pass throughs? They now have me wondering if something really overt was shown.
Claret, Ottawa, Ontario, Canada, March 23, 2011

• My father is 83 and was due to have a cardio angiogram in order to assess the viability of a biventricular pacemaker. As result of his poor kidney function it has been decided not to take this course of action. Is there an alternative test which can assess the viability of a BV Pacemaker without the resultant damage to his kidney? Many Thanks - James
James B., London, United Kingdom, February 8, 2011

• Srividya from India -- the contrast dye used in angiograms can cause damage to the kidney. Cardiologists whi perform angiograms have a number of things they can do to minimize this issue, such as hydrating the patient, using specialized and low concentration contrast solutions, etc. Cardiac CT scan also use contrast dye. Has your grandfather had a nuclear perfusion stress test? This can show if his heart is getting enough oxygen and contrast is not used here.
Angioplasty.Org Staff, Angioplasty.Org, February 3, 2011

• my grandpa with ailment in kidney is advised to undergo angiogram for suspected blocks but cautioned damage to kidney. kindly advise patient with an alternative
srividya, visakhapatnam, andhrapradesh, India, January 22, 2011

• The diagnostic pathway for diagnosing coronary artery disease (blocked arteries) has been under much discussion within the cardiology community -- whether a CT Angiogram should be the initial test, or whether it should be done in place of a standard invasive angiogram when the patient's other indicators show him to be at low risk -- in other words, why do an invasive procedure with the added risks (although low in percentage) if the likelihood of CAD is low. The downside an doing an unnecessary CT, of course, is the additional radiation -- although again in centers that have the latest equipment and training, these scans can be done with "low dose protocols". If a patient has a high likelihood of CAD, they are going to have to go for an invasive angiogram ultimately. These are complicated decisions and the answers differ from patient to patient. We suggest talking with your cardiologist and having him/her explain to you why they feel the diagnostic path they are recommending is the correct one. Also read the various articles, interviews and news items in the Imaging and Diagnosis Section on Angioplasty.Org.
Angioplasty.Org Staff, Angioplasty.Org, August 10, 2010

• I am 34 in good health. I did the stress test for 15 min. with no pain or shortness of breath. I did the nuclear stress test same results (no pain etc.) I also did the echocardiogram everything looked healthy. On the nuclear stress I had a difference on the front lobe in color. Dr. said could be a false positive. However, to be sure of no blockage he wants to do a angiogram. Should I do this at 34? Both stress test results showed low risk.
George, Thibodaux, Louisiana, USA, July 27, 2010

• Why is my Dr. pushing for angio? Recently had nuclear stress test and was told lower half of my hart is not getting enough oxygen. Diagnosed as Angina and given nitro but as of yet have have not needed to take. Scheduled for Angio in July but requests for non-invasive procedures seen to be ignored. I am also a large breasted women, so that is a concern. I am 63 years old, slightly over weight but otherwise strong as a bull and healthy. How can I get them to perform ct. first.
Concerned, Queens, New York, USA, June 23, 2010

• CHG -- not sure why you were given 3 separate CT scans -- one should have done the trick. Depending on whether low-dose protocols were used, the radiation from a CT Angiogram is the same as a nuclear stress test on the high side, and a tenth of that on the low side. MRI does not use ionizing radiationat all, and X-rays are pretty low as well. The CT Angiogram should have shown any blockages, but your cardiologist may be looking for something else. Does he offer transradial catheterization (through the wrist)? That can reduce the complications.
Angioplasty.Org Staff, Angioplasty.Org, April 30, 2010

• CHG- I had a heart attack Nov/07 and had the usual treatment incl. cardiac catheterization with a stint [stent] put in place. I was fine until last December when I developed a pain and pressure in my heart area. Since then I have had 3ct scans, 4 x-rays and 2 MRI's an echo-cardiogram along with other emergent medications. This all without any diagnosis of the cause of the pressure or pain. This all happened over a period Dec/09-the present. Now my cardiologist wants to do another cardiac catheterization. Our concern is #1 how is all the radiation I have had throughout this period going to affect me and 2. i really don't want to go through the risks that another cardiac catheterization presents. We would appreciate any advice or input you could offer.
CHG, Alberta, Canada, April 30, 2010

• Dean -- have you discussed a CT angiogram (non-invasive) with your cardiologists? Read our special section, "Patient Guide to Heart Tests".
Angioplasty.Org Staff, Angioplasty.Org, October 3, 2009

• I have had a echo cardiogram (normal),24 hour monitor (normal) and a walking stress test lasting approximately 12 minutes. During the walking test I had no pain at any time but the odd palpitation & I told was not unusual under these conditions. The heart trace during the test was fine. However, during the recovery stage they noted a small change in the trace which was considered to be either a potential blockage or reduction in flow or possibly blood pressure. My history is one where I get palpitations (quite noticeable to me), blood pressure was 139/90 but has come down to 126/76 (exercise and dietary changes)my cholesterol went from 6.6 to 7.1 hence put on statins 40mg. I have been recommended angiography. My question is, is there an alternative method which could establish whether there is a blockage/reduced flow rather than the invasive angiography? P.S. A sibling has a similar problem with palpitations and has not had to resort to an angiography, they have advised me of the potential problems using this method and that I should give careful consideration to having the angio. I am 52 & exercise 5 times a week 45mins on a bike with no problems.
Dean S., Derbyshire, United Kingdom, September 27, 2009

• Radiation is similar IF low-dose protocols are used in the CT angiogram -- if not the CT radiation is higher -- about the same as a nuclear stress test.
Angioplasty.Org Staff, Angioplasty.Org, June 29, 2009

• My Stress Test showed a spot in an artery that the Thallium did not reach. I am due to have an Angiogram in two days and am very nervous about the risks. What is the difference between the amount of radiation given in an Angiogram compared to a CT heart scan? Please advise as soon as possible. Thank you.
J. Jones, Calgary, Alberta, Canada, June 21, 2009

• There are techniques to lessen reactions, special contrast dyes that use less or no iodine and hydration protocols -- tests may need to be performed to judge exactly what in the dye causes the hypersensitivity reaction.
Angioplasty.Org Staff, Angioplasty.Org, Jun 15, 2009

• I need an angiogram but i'm allergic to contrast dye so what does one do, any help please.
Bob Cliff, London, United Kingdom, June 6, 2009

• Sam -- You might want to discuss a simple Calcium score test, which is a CT scan without contrast. It shows calcium buildup -- but that's all. Zero Calcium (or a very low score) would indicate low risk of coronary artery disease (CAD). But if the presence of CAD is already evident, as indicated possibly by the angina and CHF, then such a test would not be telling you very much that you don't already know. This is a difficult call, but it's one that needs to be made by specialists in this field, weighing the pros and cons of your uncle's specific clinical status and whether or not the angina can be controlled in other ways (medications, etc.).
Angioplasty.Org Staff, Angioplasty.Org, May 23, 2009

• My uncle is 73, CHF and CAD patient. Everything is well controlled until some recent increase in angina. His own cardiologist is reluctant to order an angiogram because of the Kidney risk. Some other hospital cardiologists brought up doing an angiogram, but the kidney risk seems like a major issue to all of them. My uncle's creatinine is slightly elevated (around 1.45), plus because of his CHF he is very volume restricted and, as I understand, effective hydration will not be possible in his case (as he could easily go into edema). What are the alternatives, while keeping the kidneys safe? I have seen an earlier answer with reference to less dye used for the CT - how much (volume) of dye is USED in CT? How much does the kidney risk go down? Any help would mean so much. Thanks.
Sam R., Vancouver, Canada, May 17, 2009

• I am 58 male. Had a DES placed last October. Prior to the placement, the cardiologist was able to due a non-invasive SCAN of my heart and found the blockage. I understand that now that the stent is placed, the test can not be done. Is anyone aware of any post Stent placement tests, scans that can be done short of going to the Cath Lab? thanks.
Lenny, Minnesota, USA, May 11, 2009

• Adams in Georgia -- nuclear stress tests have a relatively high false positive rate and many imaging specialists are now feeling that Cardiac CT, a.k.a. multislice CT angiograms, a.k.a. CCTA, are more accurate for diagnosing and/or excluding coronary blockages -- negative predictability of CT is in the 99% range -- meaning if the CCTA shows no blockage, you can be 99% sure it's correct. Without CCTA, you would probably have gone on to an invasive angiogram in the cath lab, with a 3% risk of complications.
Angioplasty.Org Staff, Angioplasty.Org, March 22, 2009

• I had a stress test and that showed a shady area - did the 64 slice CT showed 0 nothing -- said I had golden pipes.
Adams, Georgia, USA, March 20, 2009

• JC -- To answer your question, read the various interviews and news articles we have posted in our "Imaging and Diagnosis Center". These are decisions to be made between you and your cardiologist. The risks of a standard angiogram are small, but a CT angiogram (CTA) is a very accurate test for ruling out coronary artery disease and it carries virtually no risk. However, if your cardiologist believes you have a high likelihood of having a flow-limiting blockage, a catheterization with possible angioplasty is probably going to be required at some point, so a CTA won't add any information.
Angioplasty.Org Staff, Angioplasty.Org, September 13, 2008

• Lead up to flu caused heart like symptoms. EKG showed left branch blockage similar to 14 years ago but otherwise healthy heart. Did Nuclear stress this time. Stress portion went very well with no appreciable change in EKG at 174/? and 135 pulse after 7 1/2 minutes with no symptoms, 66% ejection rate. Pictures showed moderate blockage of artery leading to right chamber. Dr. want to follow up with cath. I am 61 and in good health but very anxious about risks associated with cath and am questioning whether to do it at all. Any thoughts on this?
JC, New York, USA, September 13, 2008

• Lorraine -- has your dad's cardiologist discussed the possibility of a non-invasive CT Angiogram (no catheter, done in a few minutes) to determine if he has a treatable blockage? He's on medical therapy, which works, but if he is still having symptoms which limit his activity, he, you and his cardiologist should talk.
Angioplasty.Org Staff, Angioplasty.Org, September 13, 2008

• Hi my dad had a triple bypass operation in 1989 (aged 50) and he made a good recovery within a couple of years, in 1998 he was advised to have an angiogram as some of his previous symptoms had reoccurred, under the angiogram he unfortunately suffered a stroke, from which he did make a good recovery, although it did leave some not so visible damage, the angiogram taken at that time did show that one of his arteries had a 90% blockage but because of the stroke the consultant choose to treat my dad with good medication, rather than do invasive surgery or angioplasty! He recently has had some of the reoccurring symptoms and is now 69 years old! Can you advise or give me any information to what are the alternatives to angioplasty, taken into consideration my dad's previous experiences?
Lorraine Offord, Leeds, UK, September 10, 2008

• Milda -- there are techniques that radiologists use to do studies (such as an MRA) where there is no or very diluted contrast used -- and also hydration techniques to lessen kidney damage. Keep asking questions until you find a radiologist who is familiar with these techniques.
Angioplasty.Org Staff, Angioplasty.Org, May 15, 2008

• My husband is currently on the inactive kidney transplant list. The doctors are requiring an angiogram prior to putting him on the active list. His nephrologist is telling him the dye will kill the kidney function he currently has (15%-18%). Would an MRA, or any other alternative procedure give the transplant doctors the information on his heart they require and get him on the active list.
Milda B., Ocean Park, Washington, USA, May 12, 2008

• Renuka -- in a patient such as your father, one who has a history of coronary artery disease, the standard invasive angiogram is usually the test of choice, since there is a high likelihood of finding a problem -- and a catheterization can be turned into an angioplasty if something obvious is found. Did the angiograms show any disease?? Iodinated contrast dyes, used both in catheterizations AND non-invasive CT scans, have been associated with kidney problems, and patients with low kidney function must be managed carefully for these types of tests, but we haven't seen any studies regarding an effect from dye on Potassium levels.
Angioplasty.Org Staff, Angioplasty.Org, March 16, 2008

• My dad has had a temp. pacemaker put due to low heart beat 29 . He is 71 and has already had a triple bypass 10 years ago. A heart attack a month back, an angiography 15 days ago and then this last week. All happening too fast. Potassium levels too rising. Could this be a result of the dye at the time of the angio or due to very strong medication. Had a kidney complete test done 3 months ago with all within range. Please clarify.
Renuka, Pune, India, March 14, 2008

• Cenia -- the tests you have had fall into two categories: the stress tests, whether nuclear or echo, are "functional tests" -- among other things, they measure whether or not the various parts of your heart muscle are receiving sufficient oxygen from the blood -- or how well your heart is "functioning", but they don't really visualize a blockage. The standard angiogram (or cath) actually images the arteries and any blockages can clearly be seen. A newer type of angiogram, done with multislice CT (called a CT Angiogram, or CTA), can also be done. Like the standard angiogram, it visually shows any blockages. But it is non-invasive (no cath lab) and takes about 15 minutes. It can carry a higher radiation dose than a cath, but the dose is equal to or less than a nuclear stress test. However, your cardiologist may want to do the stress test for specific reasons. Whether or not a CT angiogram would be useful for you is something you should discuss with your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, February 12, 2008

• Question about dense breast tissue and false positive/false negative nuclear scan. In 2006 I had an inpatient chemical stress test and a nuclear scan at a major heart hospital; the findings of which were various inconsequential blockages in the RCA and a major life-threatening blockage at the top of the LAD artery, so much so that I was not allowed out of bed until an angiogram could be done the next morning. The angiogram showed absolutely no blockage anywhere at all in the LAD and an 80% blockage at the top of the RCA which was stented. The false negative/false positive was blamed on dense breast tissue. Now I am due to have another stress test next week at my local cardiologist's office. He wants to do the nuclear scan and says he can take the previous issue into consideration, but I am doubtful and do not know what to do. How can my doctor know whether the results of the new scan--whatever it shows--will be trustworthy? I don't want a problem to go undiagnosed, and yet I wouldn't want to be sent for an angiogram unnecessarily. Would you please help me sort this out?
Cenia, New York, USA, February 12, 2008

• F/u to earlier post - My mother's aneurysm is in the heart (near the aorta I believe). Does this make a difference? Thanks for the info.
TD, Maryland, USA, February 11, 2008

• TD -- allergies to contrast dye are relatively specific but your concerns should be communicated clearly to the physician. You didn't mention where the aneurysm is located, but the answer is that an MRA may be an option -- there is a contrast agent sometimes used in MRAs, containing gadolinium, which has been implicated in a specific reaction in patients with impaired kidney function. But there are also techniques for performing MRAs without contrast. See our article on methods for doing contrast-free MRAs.
Angioplasty.Org Staff, Angioplasty.Org, February 11, 2008

• My mother was recently diagnosed with an aneurysm (via ultrasound). Now the Dr. wants to follow up with an angiogram to determine the nature/severity of the aneurysm. My mother is in relatively good health (for a 72-year-old) but she's extremely sensitive to meds and I'm concerned about the contrast dye. Would an MRA (mentioned above) be an appropriate alternative? If so, what are the risks with an MRA? Thanks in advance for your advice.
TD, Maryland, USA, February 11, 2008

• Jokhan -- read these posts. You could go for an angiogram, or get a multislice CTA which has been shown to be 99% accurate for negative results -- that is, if the CTA shows no coronary artery disease, you can be confident that there is none. And it's only 15 minutes, non-invasive and avoids the risks (although they are small) of the more invasive procedure.
Angioplasty.Org Staff, Angioplasty.Org, December 17, 2007

• Hi I am 30 yrs old male, having a healthy life. but Last week I felt little discomfort in my chest, somehow I got concern to meet a cardiologist. I met cardiologist, Dr suggested me for TMT. And TMT found +ve for inducible ischaemia, other things are negative. Dr's advise is, I can ignore it or I can go for angiogram for confirmation. Kindly suggest me what should I do, shall i go for angiogram?
Jokhan, Bengalore, India, December 12, 2007

• Tom -- CT Multislice and CTA are two names for the same procedure (see the Editor's Blog entry from yesterday about this -- "The Super X-Ray". Your question about whether or not CTA is equivalent to a standard invasive angiogram is most timely. The largest study yet on this subject was presented on Monday at the American Heart Association meeting (read our article about the CorE 64 Trial). CTA is pretty much an imaging mode to see structural data and blockages, not so much to measure flow, although some research on CT perfusion imaging is being done at Johns Hopkins. However, if your mother's cardiologist is concerned about blocked arteries, then CTA is an excellent test for ruling out blockages -- highly accurate (99%). We just conducted an interview with Dr. Michael Poon, president of the Society for Cardiovascular CT, and he stated that for patients where there is a question about blockages, but where the likelihood is low to intermediate, that's who CTA is for. Certainly I would ask the cardiologist more about CTA, especially for an elderly patient. The test takes 10 minutes and, outside of possible allergies to the contrast dye, there are no complications. But your mom's cardio may have good reasons why he wants the angiogram. Just make sure you understand what those reasons are.
Angioplasty.Org Staff, Angioplasty.Org, November 7, 2007

• How does a CT Multislice differ from a Coronary CTA? What are the pros and cons? Will either, or both, provide the cardiologist the same kind of diagnostic information as an angiogram? Why would my mother's cardiologist want to do the more invasive angiogram rather one of the less invasive procedures? She is almost 85 and is taking Betapace to control her atrial fibrillation. His concern seems to be centered on arterial flow from one part of the heart to another.
Tom F., Tucson, Arizona, USA, November 5, 2007

• I live near portland, oregon. My cardiologist who initiated the tests which led to my double bypass open heart surgery in june, 2006, says he wants to do another angiogram now. I don't want it, i want an alternative non-invasive procedure. What is available to me here? Who is the best known cardiologist in the Portland Or and greater Portland area who also uses non-invasive testing for 'blockage' due to sudden shortness of breath before they resort to invasive measures. I will be 68 this month. Type 2 diabetes, SLE patient but never have taken steroids, I refuse. At time of my stress test, the only part of testing which showing premature heartbeats, I had 6.8 potassium levels, a rarity for me who is usually low in potassium. My cardiologist is angry with me, but I need a 2nd opinion, where do I go please? Thank you for taking time.
Mary T., Myself fighting to live!, Oregon, USA, October 3, 2007

• Nancy -- an alternative to a cath, as you can see in this topic, is modern CT Angiography which, when done by experienced cardiologists or radiologists, can rule out the presence of coronary artery disease. The current state-of-the-art CT scanner would be a 64-slice unit. The test is fast (15 minutes), does not involve an arterial puncture and healing (just an IV for contrast injection) and is very accurate for ruling out narrowings. The downside is that contrast IS used (some people are allergic to contrast dye, some with compromised kidney function need to limit their exposure) although contrast is also used in a standard invasive angiogram. Also there is a degree of radiation exposure -- in modern systems, it's about the same or slightly more than an invasive angiogram. You can read more about the various tests used to diagnose CAD in our Imaging and Diagnosis Center. By all means, discuss this with your cardiologist. But it has been shown in several studies that If the multislice CT angiogram shows no disease, you can be confident that there is none and you can relax. When he said there was a "shady area" -- how did he see this -- what test??
Angioplasty.Org Staff, Angioplasty.Org, August 25, 2007

• My doctor said I had no symptoms but since I have anxiety attacks (thinking heart attack) he would go ahead and do a heart cath. He said one area was shady but he thought it could be where my heart is laying in my chest or the fact that I have large breasts - should I do the heart cath?
Nancy Adams, McDonough, Georgia, USA, August 22, 2007

• Tracey -- angiograms, both invasive (done in the cath lab) and multislice CT types require the use of a contrast dye for the imaging. An adverse effect of this dye is that it can cause toxicity if the kidneys are not functioning correctly -- it can even damage the kidneys. So the doctors are right in not wanting to use this until it can be determined that the kidneys are okay. There is a test that doesn't use dye -- called an MRA, or Magnetic Resonance Angiogram. These are less available than the CT or cath lab exams, mainly because not all hospitals have the equipment, or the personnel to interpret the MRA.

Once an Acute Myocardial Infarction (a.k.a."heart attack") is over, the main thing is to stabilize the patient, reduce any risk for another infarct and ultimately do an angiogram in a timely, but not emergency, fashion to assess the damage and to determine the course of treatment. And this treatment decision has recently changed: last year's OAT trial showed that opening up the totally blocked artery that caused a heart attack showed no benefit over drug therapy, once 3 or more days had passed -- which seems counter-intuitive, but the results were pretty clear. The recommended treatment for a heart attack is to do an angioplasty within the few couple of hours after the onset of symptoms, but this requires getting to a hospital that can perform emergency angioplasty quickly, and the hospital must be able to diagnose and get the patient onto the cath lab table ASAP (known as "door to balloon time"). By doing angioplasty quickly, the heart attack is in effect stopped and damage to the heart muscle is minimized. Let us know how your mother in law fares.
Angioplasty.Org Staff, Angioplasty.Org, June 6, 2007

• Hello! My mother in law is currently in ICU. She suffered what they have listed here as "Acute Myocardial Infarction with Acute Respiratory distress" her kidneys are not fully functional, but are coming around at a slow pace. Here is my question, the ICU MD wants her to have a angiogram but state they have to wait for her kidney function to recover. It has now been 3 days, she lay waiting. Is there any risk of her waiting for the angiogram? Is there an alternative test you could recommend in place of the angiogram? ICU MD's say they will not know the full damage until this angiogram is performed. Do you have any recommendations? All advice is greatly appreciated. Thank you for your time.
Tracey Thornton, Suisun, California, USA, June 6, 2007

• Nita -- your question is a bit off topic -- if there's interest, we'll start a new thread. Costs for procedures can vary quite a bit, depending on your hospital or testing center and at what level you're being tested. Also echocardiograms can vary in terms of how they are done and the different types -- for example is this a nuclear stress echo, an echo where adenosine or similar drug is used for patients who cannot perform the exercise? You also typically have a variety of charges: the echo itself, the interpretation of it, copies made for your cardiologist, etc. Our best suggestion is to call a few hospitals or test centers in your area and ask. For more information on the different tests used to determine coronary artery disease, go to our Imaging and Diagnosis Center.
Angioplasty.Org Staff, Angioplasty.Org, May 19, 2007

• What is the average cost for an Echogram? Thanks.
Nita, Texas, USA, May 17, 2007

• I have read that the average cost for an angiogram was $7,000.00 over 10 years ago. I have also read that a sonogram, ultrasound or echogram cost only a few hundred dollars. Is this information correct? Secondly, if an ultra sound test is usually step one, when and why is the angiogram, as a step 2, even needed? It's curious that I have never had a cardiologist want to do anything on me first but an angiogram and they never mention the ultrasound when I refuse the angiogram -- as I have always done. Finally, what percentage of angiograms actually trigger a blockage so that immediate invasive procedures must be taken to save the patient?
Gerald Oros, OrosCo Product Specialties, Collinsville, IL United States, October 30, 2005

• LaRee -- there are alternative tests for coronary artery disease, such as MSCT scans (read about them in our editor's Blog) that are less invasive. But if the functioning of the heart chambers is what's being looked at, then step one is usually an ultrasound, and then an angiogram. If you have questions as to whether any test is necessary, a good rule of thumb is always to ask, "How will this test change her current treatment?" If it won't, or if her ideal treatment can be found in other ways, then perhaps the test is not necessary. Any invasive procedure has risks, although percentage-wise, angiography complications are pretty low. But your cardiologist probably has specific reasons for ordering such a test. You should discuss the concerns expressed above with your doctor. And please let us know what you find out.
Angioplasty.Org Staff, Angioplasty.Org, October 15, 2005

• My mother is 83 years old, diabetic with many allegies. Her heart specialist would like her to have an angiogram because she seems to have undue pressure and enlargement in the right chambers of her heart. She gets along pretty well now and I am afraid that this procedure may cause more problems than it solves. Any information would be helpful in order to make an informed decision.
LaRee Spears, Benson, Arizona, USA, October 14, 2005

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