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Message
? for OT cardiologists and patients
Posted on 3/29/14 at 11:11 pm
Posted on 3/29/14 at 11:11 pm
Of course I am asking for medical advice on the OT. Where better?
How worrisome is an abnormal result on a nuclear stress test? Cardiologist now wants to do a CT scan. This not me, but someone I'm close to. Patient is female (no pics), forties, in good health, non smoker, and physically active. Blood pressure and other tests are normal. TIA
How worrisome is an abnormal result on a nuclear stress test? Cardiologist now wants to do a CT scan. This not me, but someone I'm close to. Patient is female (no pics), forties, in good health, non smoker, and physically active. Blood pressure and other tests are normal. TIA
9
Posted on 3/29/14 at 11:12 pm to Jim Rockford
You've come to the right place.
Posted on 3/29/14 at 11:14 pm to Tigerlaff
That's why I'm asking. The OT is the source of all knowledge 
Posted on 3/29/14 at 11:16 pm to Jim Rockford
:|
This post was edited on 3/29/14 at 11:18 pm
Posted on 3/29/14 at 11:17 pm to Jim Rockford
Jax, who post in the beer thread on the food board, just had a quadruple bypass because he failed one of these.......it is serious.
Posted on 3/29/14 at 11:23 pm to Mr. Allman
NOLA area. That's what I was thinking, too. She had an episode of chest pain a few weeks back. Dr thought it might be reflux related, or maybe a kidney stone, but ordered up the stress test, now wants to do the CT
Posted on 3/29/14 at 11:25 pm to Jim Rockford
quote:
How worrisome is an abnormal result on a nuclear stress test? Cardiologist now wants to do a CT scan. This not me, but someone I'm close to. Patient is female (no pics), forties, in good health, non smoker, and physically active. Blood pressure and other tests are normal. TIA
Needs further eval. Wouldn't waste money on the CTA though. I'd just do the heart cath. It's the gold standard and only way to know 100% whether you have blockage or not. And if there is, they might can stent then and there avoiding more testing. That's what I'd request.
Posted on 3/29/14 at 11:27 pm to Mr. Allman
quote:
If they were that worried about it, they would bring her straight to the Cath Lab instead of sending her for a CT.
Unless they're trying to milk out every dollar they can. A CTA is a screening test, just like the stress test. Only one of the two is needed. If abnormal, you go to cath lab.
Posted on 3/29/14 at 11:27 pm to SmackoverHawg
Well there's no way she's going for a cath at this stage. The doc had to talk her into agreeing to a CT.
Are blockages common in non-elderly women? I certainly don't hear of it very often.
Are blockages common in non-elderly women? I certainly don't hear of it very often.
Posted on 3/29/14 at 11:31 pm to Jim Rockford
This could very well be serious. My mom had a stress test, came out fine, then a nuclear stress test, came out fine, but just in case the doc wanted to do a cath, then they found a 98% blockage. I'd imagine an abnormal stress test could be serious.
This post was edited on 3/29/14 at 11:32 pm
Posted on 3/29/14 at 11:47 pm to Jim Rockford
They're doing a CT scan as a precaution/additonal testing. Probably nothing at all to be worried about. 40 year old woman,non-smoker isn't going to be sent straight to the cath lab. If it were something serious, she'd have gotten an angiogram by now (or at least scheduled for one).
Posted on 3/29/14 at 11:48 pm to Jim Rockford
An abnormal nuclear myocardial perfusion scan (one of the more common 'stress tests') can indicate that portions of the heart are not receiving enough blood supply (oxygen) during peak stress levels i.e. running on a treadmill. The scan compares uptake levels of a certain nuclear marker at rest to levels at peak exercise (stress). A decrease in uptake may indicate a blockage and decreased oxygen delivery to that area (ischemia).
Your friend likely had an area of decreased uptake thus the abnormal results. It's hard to say this is of much merit but it certainly involves further investigation, especially if the patient is having episodes of chest pain. The definitive answer relies on cardiac catheterization where dye is injected into the coronary arteries and the blockage can be quantified. Cardiac CT is also up and coming but unfortunately no intervention can be done right away like a Cath can.
Your friend likely had an area of decreased uptake thus the abnormal results. It's hard to say this is of much merit but it certainly involves further investigation, especially if the patient is having episodes of chest pain. The definitive answer relies on cardiac catheterization where dye is injected into the coronary arteries and the blockage can be quantified. Cardiac CT is also up and coming but unfortunately no intervention can be done right away like a Cath can.
Posted on 3/30/14 at 2:01 am to pleading the fifth
quote:
Cardiac CT is also up and coming but unfortunately no intervention can be done right away like a Cath can.
I know three people who recently had symptoms that would have previously resulted in a immediate trip t0 the cath lab, instead less invasive testing was done, and this was with three different cardiologist, is there a shift in philosophy occurring?
Posted on 3/30/14 at 4:44 am to EA6B
quote:
is there a shift in philosophy occurring?
There is a shift in insurance coverage occurring.
Posted on 3/30/14 at 5:56 am to Traffic Circle
Why did she have the test in the first place? Just screening?
What kind of family history does she have?
As above said, ct is another screening test, expensive.
Heart cath is the standard. If no blockage, no problem.
If ct was positive , she'd still have to have a cath.
What kind of family history does she have?
As above said, ct is another screening test, expensive.
Heart cath is the standard. If no blockage, no problem.
If ct was positive , she'd still have to have a cath.
Posted on 3/30/14 at 6:58 am to chuckie
She must have good insurance if they want a cta after an abnormal nuc.
I would go straight to cath lab.
How much does she weigh? False positives are common on large womenz with big breasts
I would go straight to cath lab.
How much does she weigh? False positives are common on large womenz with big breasts
Posted on 3/30/14 at 6:59 am to chuckie
As I mentioned upthread, she had an episode of chest pain. Dr didn't think it was heart related, but ordered the test anyway. No family history of heart disease, non smoker, very physically active. Normal wt, normal BP.
This post was edited on 3/30/14 at 7:01 am
Posted on 3/30/14 at 7:00 am to Traffic Circle
quote:
is there a shift in philosophy occurring? There is a shift in insurance coverage occurring.
Appropriate use criteria.
Posted on 3/30/14 at 7:17 am to bushwacker
How diagnostic is the CT scan now?
My friend is 46 and has all red flags. Overweight. Smoked but quit. Daily drinker. Eats like shite. Poor family history. High cholesterol. He had CP and went to ER. Sent home after overnight troponin. X 3. Followed up with cardiology. They stressed him and said abnormal but will monitor it and change meds?
Btw he was cathed 10 years ago and had 20-30% blockage. I have been in ER for over 12 years and can't wrap my head around this.
My friend is 46 and has all red flags. Overweight. Smoked but quit. Daily drinker. Eats like shite. Poor family history. High cholesterol. He had CP and went to ER. Sent home after overnight troponin. X 3. Followed up with cardiology. They stressed him and said abnormal but will monitor it and change meds?
Btw he was cathed 10 years ago and had 20-30% blockage. I have been in ER for over 12 years and can't wrap my head around this.
Posted on 3/30/14 at 7:18 am to SmackoverHawg
quote:
Unless they're trying to milk out every dollar they can. A CTA is a screening test, just like the stress test.
False. A Calcium score CT is a screening test.
A coronary CTA does provide real info on stenosis. It generally will overestimate stenosis compared to a traditional cath though.
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