Re: Stress Test - worth the effort?

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@xxxxxxxxxxxxxxxxxxxxx

.

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