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Current Postings on This Page (25):
• So many stress tests are unnecessary, but it
is a great way for cardiologists to earn anywhere from $400,000 to $1 million
a year. This explains why according to UN studies, the USA is ranked 37th
in healthcare and number 1 in costs per patient. It's disgusting. It's
also the single most important reason why I supported President Obama's
healthcare legislation. It will reduce repetitive testing, and hold physicians
more accountable for these tests,so many of which are unnecessary.
Maurice, San Francisco, California, USA, July 9, 2010
• Julia -- stress echocardiograms are excellent
diagnostic tools to view the action of the heart valves -- we assume that
the results will shows if your aortic valve is working correctly.
Forum Editor, Angioplasty.Org, date, 2010
• What are some important questions I should ask
my cardio next week? 42 year old female had aortic root enlargement and
replacement 9 years ago. I had a breathing test, rest echo, chest X-ray,
thyroid test, magnesium test, holter monitor test. He said is wasn't
time to replace the tissue valve yet and ordered a stress echo. all tests
to
this point were good. I have migraines, nausea, shortness of breath during
activity, benign palpitations, fatigue, my legs and arms ache and feel
like they go to sleep with activity. During the stress echo they pushed
me as far as I could humanly possibly go, with a 200 bpm 7 minute workout.
I didn't pass out but was on the verge. They wouldn't tell me the results
on Friday afternoon as the cardio has to read it. What will the stress
echo show and what questions should I ask when I get my results, does
it sound like standard procedure? If everything comes back fine here then
what. I know what I felt like before replacement do I just chalk it up
to being out of shape and resume everyday life feeling miserable, if
this
is normal I will but don't want to keep paying for unnecessary tests.
Thank you.
Julia, Denver, Colorado, USA, June 20, 2010
• Performing a CT angiogram as an alternative to
stress tests has been studied and the CTA has scored pretty well. It's
non-invasive and can be done with low-dose radiation protocols. Cardiologists
who have worked with CTA feel strongly that it should be the preferred
test (read the interviews with various experts in our "Imaging
and Diagnosis Center". The negative predictability of CTA is very high, so if the CTA
shows no coronary disease,
there
isn't any.
Forum Editor, Angioplasty.Org, June 4, 2010
• I'm a 67-year-old female. For about four months
I have had a mostly mild ache in the left breast area which is accompanied
by mild ache directly back to the left shoulder blade and left arm. The
discomfort comes and goes but is usually present, and usually at only a
mild level. Exertion seems to increase it somewhat, but not dramatically.
I had an echo cardiogram and nuclear stress test and both were normal.
I'm on low-dose aspirin and pravastatin for cholesterol. The ache continues.
The cardiologist I saw put me on omeprozol for acid reflux a couple of
months ago, but it hasn't helped. He suggested doing an angiogram, but
I don't want to be an alarmist and pursue medical testing when it's not
strongly indicated. I have three brothers with heart conditions (by-pass
surgery, stent, and angioplasty). Does my situation sound familiar to anyone.
I am generally
healthy, exercise regularly, and not inclined to frequent "doctoring".
Kay P, Arizona, USA, May 21, 2010
• My Mom is almost 90 and her doctor wants her
to do a stress test, of course w/walker or something to hold onto. She
was diagnosed w/Angina. I do not feel it's necessary or safe, as I have
heard stress tests can bring on a heart attack. A heart doctor who operated
on my Uncle about 8 years ago told me that. Thanks.
Debi, Florida, USA, May 20, 2010
• Adam -- read the related topics in the right hand
column for more info on what these tests show. False positives
are not uncommon in stress tests. Some cardiologists feel that CT Angiograms
are more accurate for ruling out blockages in the coronary arteries.
Forum Editor, Angioplasty.Org, May 14, 2010
• i had a stress test 3 wks ago which showed that i might have blockage
in my artery. My dr suggested having a nuclear stress test to be sure. He did
mention it could be a false positive. I had the nuclear, and it came back perfectly
normal. Why would the first test show something the notes said possibly a 2mm
blockage.
Adam, Long Island, New York, USA, May 12, 2010
• I had five stents put in last September after
a nuclear stress test showed problems. My doctor has now ordered a stress
test for me but the insurance company denied it saying it could be done
every two years. Am I in trouble?
Margaret M., Brooklyn, New York, USA, September 18, 2009
• Suzanne -- Has your cardiologist suggested getting
a CT Angiogram to see if in fact you have any blockages? It's non-invasive,
although it uses IV contrast dye and only take a few minutes. If you
do, make sure the provider uses the most current low-dose protocols to
minimize
radiation.
Forum Editor, Angioplasty.Org, September 16, 2009
• Could someone please tell me the significance
of "Ischemia is seen at the apex." I had an MPI study with adenosine (I
could not do the treadmill because of severe pain associated with a GYN
problem, which has since been resolved with surgery). The only other abnormality
mentioned on the test was a "small, mild perfusion defect at the apex that
re-perfuses with rest." NO ekg changes were seen (and that includes ST
depression which often means ischemia). I am on Lipitor 40 mg/day, ASA
81mg and metoprolol 25mg (my HR usually ranges from 46-54 daily).The doc
wants me to be cathed. I do not want to go to cath lab because I do not
want angioplasty, not the least reason is because I am allergic to metals.
Can't wear jewelry, even earrings with surgical stainless bother me. I
have been reading the posts about a stenosis may be >70% but unless it
its flow-limiting (does this mean ischemia????) it may not need
to be addressed. The reason I had the nuclear perfusion study: My GP referred
me to cardiology because of a coronary calcium score of 285. I was already
on Lipitor 10mg which brought my TC down from 262 to 179; brought LDL from
175 to 104. TG was always low at 63. PLEASE help!
Suzanne A., Norman, Oklahoma, USA, September 12, 2009
• I had a stress test done about a month ago indicating
a probable blockage. It was nuclear [well I did walk on a treadmill,
they injected some stuff and made me sit real still on a machine that
rotated around me] they did this both at rest and after excercise. Anyway
as
a
result I was followed up with a cardiac cath that came up clean. Something
the FIRST doctor did not mention that women with ample breasts can
have about a 20% false positive rate because of interference with the signal
through the breast fat - it would have been nice to have been told
about
this up front and I would not have been as freaked out as I was.
Nancy, South Carolina, USA, May 23, 2009
• Kevin -- a nuclear stress test is normally given
if the patient is symptomatic (angina, etc.) and the cardiologist wants
to see if there is ischemia. An exercise stress test can tell some things,
but doesn't really give much information about coronary artery disease.
Other non-invasive tests to find out about CAD are a Cardiac CT Angiogram,
or even a simple Calcium Score, a low radiation CT look at the calcium
in your arteries. Note that while much has been published in the popular
press about the radiation doses from Cardiac CT, a nuclear stress test
exposes the patient to as much if not more radiation than a Cardiac
CT Angiogram.
Forum Editor, Angioplasty.Org, May 20, 2009
• I just fired my cardiologist for attempting to
pad the office bill by adding an unnecessary nuclear (adenosine) stress
test. I didn't go along with it. According to the American Society of
Nuclear Cardiology an exercise stress test is indicated for me since I
am in good
health, I'm 54 years old, I exercise quite often (walk 20+ miles/month),
I have no recurring angina since my ischemic attack and subsequent stent
emplacement in 2006, I have no exercise restrictions, and I am not disabled,
feeble, or have trouble following directions or walking or even running
briskly for 20 or 30 minutes. The difference: An exercise stress test
costs $250 of which I pay all with deductible. The nuclear stress test
costs
$4000 of which I pay $1000 with deductible. Since it's a huge cardiac
practice, they do all their own tests on-site. I can only surmise that
she wanted
to pad my bill. I gave her the heave-ho and am now managed by a GP who
will refer me
to a cardiologist when she feels it is necessary.
Kevin, Albuquerque, New Mexico, USA, May 18, 2009
• CA -- while it's hard to understand how a nuclear
stress test would not show any ischemia in a patient with 85-95% blockages
in four arteries, it is an example of why
many of the imaging specialists interviewed in our Imaging
and Diagnosis Center believe
that
Cardiac CT
Angiography (CCTA) should be the primary test for coronary artery disease.
Forum Editor, Angioplasty.Org, May 17, 2009
• Hi, On April 22, I had a nuclear stress test
and blood work...well 8000.00 worth and got the green light! My heart
was in perfect shape..On the 25th I had a major heart attack in the ladies
restroom at a roping. I died and then came back..Needless to say, I had
85-95% blockage in 4 arteries. I am home now, my Dr. put 5 stents in,
but
I am having chest pains quite often and a little shortness of breath.
I take the nitro and get some relief but I don't know how many times a
day
I can take it? For every episode? Are these chest pains normal? I am
trying hard not to be afraid!! Anyone have any answers?
CA, Monahans, Texas, USA, May 17, 2009
• I had a stress test done. The Dr. said I have
all the criteria for a blockage but he could not see one. I had a positive
d-dimer, and the velocity measured in my right Artery was very high, and
it was also not right in my legs. The dr. explained it was like putting
his thumb over the end of a water hose and it increasing the pressure.
He advised me to lose weight and relax more.... but everything else was
ok... my sugar, cholesterol, salt intake. He said he kind of was looking
for some of that to be "off" so that he could say that maybe it was some
of the problem, but it wasn't. Should i also have my head checked for blockages,
could it be there? Should I get a second opinion?
Sherrie Wisdom, McKenzie, Tennessee, USA, April 28, 2009
• On 8-15-08 I had every symptom for a heart attack
known. I being the "It's
not happening person" did not go to the Hospital. I did call my Dr. and he ordered
a Thallium Stress test. I just got the results by phone and was told everything
looked normal. Does anyone know, is it possible to have a heart attack and it
not show up on this test? You couldn't order more perfect symptoms of a heart
attack that I experienced.
If anyone can help, please advise.
Tim, Ohio, USA, August 26, 2008
• Jeanne -- a nuclear stress test is done to see
if the heart is getting enough oxygen/blood. There is radiation associated
with the test, about 15 millsieverts, so it's not a test you'd want
to get annually, unless there's a compelling reason. You are diabetic and
have already had a stent placed. Published
guidelines find it reasonable to be tested two or more years after a
normal
result. One question for your cardiologist is that the imaging/testing
pathway is undergoing revision and some cardiologists feel that Cardiac
CT Angiograms
can be
done with less radiation, and are more accurate for excluding coronary
artery disease.
Forum Editor, Angioplasty.Org, June 26, 2008
• I had a heart attack 3 years ago and had a stent
inserted. After 2 years the doctor took me off Plavix, but I am still
taking 81mg aspirin daily, among other meds for Type 2 diabetes, blood
pressure
and osteoporosis. I am active and feeling fine. Is it recommended (or
necessary) that I take a nuclear stress
test annually?
Jeanne, Florida, USA, June 22, 2008
• I had a thallium stress test in February 2006
after nearly 2 weeks of mild to severe chest pain while walking. I was
sure it wouldn't reveal anything
significant but the nurse stopped the stress test early, put me on oxygen and
said my ECG was abnormal. Even though the thallium test prior to the stress
test was normal the nuclear test afterward showed major blockage - 90%
in the LAD
and 70% in the left circumflex. I checked into the hospital that night and
experienced intense chest pain while at rest. When I had the angioplasty,
the cardiologist
said the LAD was actually 100% blocked and the left circumflex was 90% blocked.
He also found and removed a blood clot and said that I had good collateral
circulation from my RCA which is what prevented me from having a heart
attack. I'm convinced
the nuclear stress test saved my life. If I had not had it, I'm sure I would
have suffered a fatal heart attack.
Albert S., Illinois, USA, February 25, 2008
• I would have to agree, with stress test, being
a waste of money and time. I was sent for a stress test because I was
complaining of chest pain, and finding it hard to breathe at times, now
the magic of
this is, AT TIMES. The stress test showed there was nothing wrong with
me, everything was normal, or as normal as could be after going through
an MI, so home I go, everyone thinking the problem has been cured, I
am on my way to recovery when BAM I have a major MI, my stent was closing
over on one end, and had closed causing a MI. But hours prior to that
I
was fine and the stress test proved that, sometimes I wonder, That stress
test proved to my boss that I was fine and should have been at work,
but I wasn't and I got fired, sooooo, when a stress test is mentioned to
me
I just laugh,
and say no thanks.
Patsy Wellwood, Nova Scotia, Canada, February 15, 2008
• Dr. R. -- your observation is correct that stress
tests, including nuclear stress tests, are not as accurate in diagnosing
CAD as other tests -- and this seems especially true in women. They are,
however, important in determining whether there is a functional deficit
(not enough
blood
getting
to the
heart muscle).
CT Angiography (CTA) is much more accurate in ruling out CAD (99+% in
all current trials) -- somewhat less so in positive results. A number of
imaging
specialists we've spoken with think that CTA will replace many of the
thallium stress tests -- although if CMS decides to cut back CTA reimbursement,
this won't happen as quickly.
Forum Editor, Angioplasty.Org, February 14, 2008
• Since there was no question in your post I am addressing a different aspect
of the topic you bring up and then invite the editors to comment. I am a physician
whose mother at age 75 had an MI 6 months after a negative stress test. This
caused me to research the literature. From my research I have concluded, in my
OPINION, stress tests are among the biggest scams in mainstream US medicine.
First, pretty much all of the research I found was done on 55 year old males.
Secondly, they are about 75% accurate in predicting CAD. Sounds good. But this
means if you do 1,000,000 in a year you will have 150,000 MISSED cases of CAD.
Not very good. Could the money spent on stress tests be better spent in our very
wasteful US healthcare system (I also have a management masters degree)? I believe
so. What do the editors think? Have I misinterpreted the data?
Dr. R., Pennsylvania, USA, February 14, 2008
• I just had a thallium stress test. My pulse was
in the low forties and would go to the low fifties and return to the
40's. The medication caused me chest and neck pain and the stress test
could
not be finished. Diagnosis: ischemia.
Anna L., Wyoming, USA, January 26, 2008
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