Question:
Visited a (supposed to be) cardiologist last week - he wanted me to have
a stress test, but I declined and he lost interest in having me as a
patient.
I had a triple bypass 10 years ago, and since them have had stents put
in on 4 separate occassions. Same thing happens each time - I have the
angioplasty/stent then about 4 to 8 weeks later my angina and shortness
of breath returns - gradually gets worse and worse until I can only walk
(say) 20 metres before needing to take an anginine tab, then the tabs
are not enough to stop the pain and I go to hospital.
I had the last stent in Jan 04, and am now at the point where I think I
need another op - pain on exertion (eg drying myself after a bath) and
pain after eating a heavy breakfast.
So, I went to see this guy after getting a referral from the GP/
I hate those stress tests as I think they may bring on a major heart
attack, and also it seems a waste of time and money. If the test turns
out bad I will need an angiogram/plasty to find and fix the problem, and
if it turns out good then I will need an angiogram to find the problem.
Either way I will need the angiogram, so why go thru the hassle of a
stress test?
Answer:
It sounds like you are from Australia and I'm not quite sure how things work
there, but I assume there are some similarities with the US.
Here there are medical protocol issues. I recently had two stents put in. I
was very sure of what was going on and it turned out I was right. But me being
very sure does not satisfy either the Dr. who is going to do the procedure or
the insurance company. So I had to go through the process of making an
appointment with the cardiologist and then getting a nuclear stress test -
which showed a part of the heart was not getting enough blood.
So there are rules the medical establishment and insurance companies impose.
I suggest you might want to follow your Dr's. advice and take the test. Since
your alternatives seem to be to take a long trip which may well put you back
in the same boat. Or living with the problem which is likely to get worse.
FYI, there are new types of stents out there, which you may or may not have
had in 01/04, call drug eluting stents which are much less likely to reblock.
And if you keep having new blockages, such as the one you suspect now, you may
want to see if there is anything more you can do to slow that process down.
Diet and exercise are the first place to look.
A stress test without any imaging doesn't have much value in someone
with known coronary heart disease who is having their classic angina.
However if done with radionuclide imaging (for instance, thallium stress
test) it can give a sense of how much and what parts of the heart are at
risk from inadequate blood flow and that can help guide management.
The risk of a heart attack during a stress test is very small.
Unfortunately if they use those stents I would have to pay for them - they did
give me that option with my last procedure, but I dont have that sort of money to
spare. Also, none of the previous stents have reoccluded - it has been a new
blockage each time.
Could you elaborate on that a bit David as this is what I am not sure about.
Either way I need the angiogram and angioplasty, so am wondering what change
in management could result from the stress test. What will it show that the
angio will not?
The last Thallium test I had (about 9 years ago) was inconclusive as the guy
cut the test short because I was in such pain (I told him before the test
that it was a waste of time, but went along with it :-( ) and the bastard
still tried (unsuccessfully) to charge me for the test even though he stuffed
it up!!
I guess you know, but when my arm is aching and paining like mad, I can
hardly breathe - gasping for breath, and my chest feels like an elephant is
sitting on it, it FEELS like a heart attack is about happen.
