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Current Postings on This Page (32):
• 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.).
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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??
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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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related topics
• Multislice
or Multidetector 64 Slice CT Angiogram |
