From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med.cardiology
Subject: Re: Stress Test - worth the effort?
Date: Wed, 29 Jun 2005 19:01:53 -0400
Message-ID: <d9v99a$gie$1@reader1.panix.com>

quietguy wrote:
> 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?
>
> As I live in the bush their is only the one so called cardiologist handy
> - so a second opinion means a 1000km trip
>
> Any ideas, suggestions?
>
> David - who is of course on regular heart medication

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.

--
David Rind
drind@caregroup.harvard.edu

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med.cardiology
Subject: Re: Stress Test - worth the effort?
Date: Wed, 29 Jun 2005 22:35:02 -0400
Message-ID: <d9vlou$gea$1@reader1.panix.com>

quietguy wrote:
>
> David Rind wrote:
>
>
>>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.
>
>
> 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 angiogram will show narrowings in specific blood vessels, and the
cardiologists can try to judge if these are important based on how
narrow each vessel is.

A thallium stress test shows blood flow to the heart muscle
("perfusion") and may show regions of the heart that are not getting
enough blood during exercise. Some narrowings of blood vessels may not
be causing a lot of problems with blood flow to the heart, or the entire
region that is not getting enough blood may be very small so that a
heart attack would not result in much loss of heart muscle. In contrast,
the thallium study might show that a large portion of the heart is at
risk and a heart attack would likely be extremely serious.

This can help make decisions about which blood vessels to try to stent,
whether any procedure is necessary at all, or whether surgery is really
what is needed because lots of heart is at risk from various narrowings.
(This is just to give a flavor of the issues -- this is really too
complex for a newsgroup posting.)

As you suggest, if you need an angiogram either way, a stress test
without thallium will not provide much useful information. (It can still
give some hints about which blood vessel narrowings are responsible for
the chest pain and how much heart is at risk, but it's pretty unreliable
at this.) But a thallium stress test may well provide useful information.

>>The risk of a heart attack during a stress test is very small.
>
>
> 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.

They shouldn't generally be having someone keep exercising past the
point where pain and shortness of breath have occurred.

--
David Rind
drind@caregroup.harvard.edu