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Stress Test is worse, Catheter the same.
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Padawan posted:
I have a family member who has had a 40% blockage in their coronary artery for the past 5 years (at least this is when the blockage was detected). Since then, this person has been seen by his cardiologist 3 times in which each visit yielded a stressed test followed by a catheter. The first 2 times these tests were performed, my family member failed his stress test while the catheter revealed a 40% blockage. This 3rd and last series of tests revealed the same, however, the cardiologist mentioned that the latest stress test looked a bit worse than the previous 2 tests. Even though the cardiologist mentioned this, there was no further course of action leaving my relative concerned about his worsening stress test results.

Therefore, my question would be: can a stress test reveal something that a catheter cannot? From what I understand, a stress test will show blood flow to the muscles of the heart, while a catheter focuses more on any blockage. I understand that there is often times a correlation here, however, I am guessing that other factors such as valve function etc that can lead to a worsening stress test while not being detectable by a catheter. Should my family member request a follow up as to why his stress test has worsened but his catheter results stayed the same?

Thanks!
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cardiostarusa1 responded:
Hi:

"Can a stress test reveal something that a catheter cannot?"

For good detailed info, see -

HeartSite

Isotope/Nuclear Stress Test

SEE: Actual rest/stress nuclear images

.http://www.heartsite.com/html/isotope_stress.html


Cardiac Cath

http://www.heartsite.com/html/cardiac_cath.html


"From what I understand, a stress test will show blood flow to the muscles of the heart, while a catheter focuses more on any blockage. I understand that there is often times a correlation here."

That is correct.

Even though invasive heart catheterization (X-ray angiography, angiogram) is stll considered as the current "gold standard" for imaging blockages in the coronary arteries and for determining the severity (%) of the blockage(s), it does have its limitations, is not 100% perfect, no diagnostic imaging is. As reported, sometimes it may/can underestimate or overestimate the degree of stenosis (narrowing).

There's a seldom talked about/discussed term known as fractional flow reserve (FFR), which uses a tiny wire that accurately measures blood pressure and blood flow through a blockage in a coronary artery, and can be performed at the same time as an angiogram (heart catheterization)

According to various medical literature and media reports, FFR measurement has proven to be very useful in determining if the interventional cardiologist should perform angioplasty, with or without stenting, on blockages such as 50%, give or take a little.

"I am guessing that other factors such as valve function etc that can lead to a worsening stress test while not being detectable by a catheter."

Yes, heart valve problems, heart chamber problems. Sometimes even minor ones can make a stress test appear worse, though actually does not affect blood flow to the heart muscle (myocardium).

"Should my family member request a follow up as to why his stress test has worsened but his catheter results stayed the same?"

Yes, of course.

Coronary artery disease (CAD) is a lifelong unpredictable (can exhibit periods of stabilization, acceleration, and even some regression) condition, requiring a continuum of care, as well as good doctor-patient/patient-doctor communication and understanding at ALL times.

Best of luck to the family member.

Take care,

CardioStar*

WebMD member (since 8/99)




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Be well-informed


Living with Heart Disease

Coronary artery disease (CAD)


CAD is a chronic disease with no cure. When you have CAD, it is important to take care of your......

Recognize the symptoms......

Reduce your risk factors......

Take your medications......

See your doctor for regular check-ups......

http://www.webmd.com/heart-disease/guide/living-with-heart-disease

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Coronary artery anatomy

Starting with the left anterior descending (LAD), the most critical, next to the ultra-critical left main (LM).

http://www.heartsite.com/html/lad.html


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Heart Disease TYPES

Men and Women

Acquired in life or congenital (born with it)

http://www.webmd.com/heart-disease/heart-disease-men

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http://www.webmd.com/heart-disease/guide/heart-disease-symptoms

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Heart Disease

Heart disease is a broad term used to describe a range of diseases that affects your heart and sometimes the blood vessels......

http://www.mayoclinic.com/health/heart-disease/DS01120

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The Heart: (Human Anatomy) Pictures, Definition, Location in the Body and Heart Problems

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billh99 responded:
There are several types of stress test.

The basic one just uses EKG monitoring. The result is bases on how long you are able to exercise, the heart rate reached, if there where any changes in the EKG, and if you reported any angina or shortness of breath.

Another is similar, but it is combined with echocardiogram. A detailed echo study is done before the stress test. Then immediately after exercise another echo is done while the heart is still beating hard.

The echo adds such things as valve restrictions or regurgitation, size & thickness of the heart muscle and the wall motion of the heart.

Another type of stress test is the nuclear which CS discusses. The nuclear looks areas of the heart that might have reduced blood flow.

Get a copy of the test. Then you can see exactly what has changed. Then you can ask the cardiologist what is the meaning of those changes and how significant that they are.


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