Doubt validity of Nuclear Stress Test
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bertwig posted:
I recently developed suspicious symptoms while walking/running:
Tighness in chest, tighness in both shoulders and left arm, tightness in neck, slight pain in jaw. I am 77, Type II diabetic and high cholesterol controlled by Lipitor. My PCP gave me an EKG, which showed nothing, he referred me to a cardiologist where I was given a Nuclear Stress Test.
The first part I was injected with some substance, given a sonogram, and photographed with a special camera. They had me eat a snack, injected me with a radioactive (?) substance which was supposed to simulate stress on the heart. After waiting slightly over an hour, I was then photographed. After being injected with this second substance I felt nothing unusual, no rapid heart beat, no increase in blood pressure, no noticeable increase in heart rate.
The results of the test were negative, my heart and blood vessels were ok according to the Nurse Practioner who interviewed me. He suggested that I may have indigestion and recommend over-the-counter Zantac.
I still have these symptoms, beginning after only slight exertion. this morning I walked about a mile and the pressures and jaw pain commenced within the first 100 yards.
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billh99 responded:
Since you are physically fit and I wonder why they did they did not do a treadmill (or cycle) stress test.

I have not had a pharmacological stress test, but my understanding is that you should have a definite physical response to the test.

http://www.heartsite.com/html/chemical_stress.html
http://health.cvs.com/GetContent.aspx?token=f75979d3-9c7c-4b16-af56-3e122a3f19e3&chunkiid=569468

Since you did not talk to the cardiologist and PCP are usually more available make an appointment with your PCP.

Have your PCP get the details of the test and ask about you apparent lack of response.

Also since you are have what might be angina ask him about getting a script for nitro or similar pill that you take when you have the symptoms. And if that stops them, at the time, it might be more evidence of heart disease.

However, I have no idea how appropriate that would be.

I realize that this is first time and don't know what to expect.

But I have learned to be proactive. When you are going to have a test look it up. Know what to expect. Know what the possible results are.

Then, if needed, you can ask question during the test if you are experiencing anything different than expected.

And ask the doctor detail questions about the results. Not in an accusatory manor, but rather in wanting to learn more about your condition.

The something with a procedure or new med.

While I can't be sure, it appears to me that doing that the doctors are more open and work more as a team.
 
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cardiostarusa1 responded:
Hi:

......"substance which was supposed to simulate stress on the heart / I felt nothing unusual, no rapid heart beat, no increase in blood pressure, no noticeable increase in heart rate."

"The results of the test were negative, my heart and blood vessels were ok according to......"

Curious as to what chemical stressor/drug was administered? Adenosine, Dobutamine or Persantine (all three being non-radioactive).

On the flipside, some individuals have reported side effects/adverse reactions from having a chemical stress test which include, but are not limited to, anxiety, dizziness, flushing, headache, nausea, panic, shakiness, chest and/or arm pain, irregular heartbeat (e.g., palpitations), dyspnea (shortness of breath), heart attack (though considered rare).

Even when it goes off without a hitch, the main problem with either pharmacologic (chemical-induced) or exercise (treadmill or stationary bicycle) nuclear stress tests, is that from time-to-time, it can yield a false-negative or false-positive result.

One example, and at the very extreme, a nuclear stress test can appear normal in some individuals with multi-vessel coronary artery disease (CAD), said to occur due to so-called "balanced ischemia"

Beyond the nuclear stress test, as applicable for the patient, there is also the non-invasive 64-slice Cardiac CT, which does not rquire stressing the heart, and allows doctors to view/examine the heart and the coronary arteries in never-before-seen detail.

Far better yet, the newer blazingly fast (benefit of less radiation exposure to the patient, and less contrast media) 320-slice Cardiac CT scanner can measure subtle changes in blood flow, or minute blockages forming in blood vessels, no bigger than the average width of a toothpick (1.5 mm) in the heart, and the brain

"He suggested that I may have indigestion and recommend over-the-counter Zantac. I still have these symptoms, beginning after only slight exertion. this morning I walked about a mile and the pressures and jaw pain commenced within the first 100 yards.".

As reported, the symptoms of artery-narrowing atherosclerosis are highly variable. Those with mild atherosclerosis may present with clinically important symptoms and signs of disease and heart attack, or absolute worst case scenario, sudden cardiac death (SCD) may be the first and only symptom of coronary artery disease (CAD). However, many individuals with anatomically advanced disease may have no symptoms and experience no functional impairment.

ALWAYS be proactive in your health care and treatment. Sometimes this requires being assertive.

Best of luck down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)



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