Angiograms and other Heart Tests

[Jean]

Recently I had a nuclear stress test. The results showed I had a 75% blockage in the left ventricle and a leaky valve. Decision was made to have an angiogram. This took nearly a month to get scheduled, a month full of worries and all the things that could go wrong. Went in for the test yesterday, the Dr. came in and told me I had a badly leaking valve and they were going to fix it. Did the angio, came out and was laying in the bed when in comes the Dr. And, guess what? I have no blockage, no leaky valves, my heart is very strong and has made its own bypasses. What??? So, I asked the nurse how two tests could come up with such diverse results? To me, this was mind blowing. She told me the nuclear stress tests are not all that conclusive and, in women, are very often wrong. I would assume that is hooey, but, a dear friend of mine had the same thing happen to her. From the stress  test, they predicted open heart surgey and from the angiogram, nothing needed to be done. I gotta tell you folks, this is scary. Seems that the stress test could have easily been eliminated. Not to mention all that my family and I went thru in the weeks in between. The worry alone could have caused a heart attack, if I had a weak heart as the stress test said I did. Beware what tests your Dr. sets up for you.

[okarol]

Wow that is perplexing! 
I hope it means you're A-OK Jean!!

[MooseMom]

Jean, that is unbelievable.  The stress you've gone through over all of this...all for nothing (which I guess is a good thing, really!).  When I was scheduling my stress test, I talked everyone into letting me just do a treadmill test because I really didn't like the idea of the whole five hour thing where they chemically induce cardiac stress.  Well, even though I had stopped taking my beta-blocker 24 hrs before as required, I still couldn't get my heart rate high enough, so I had to get a referral for the chemical stress test, and what a palaver that was!  I had the test done and hated hated hated it...it took up my whole damn day.  A few weeks after that, I read an article in the paper about a study done that concluded that stress tests are next to useless for women.  We all know that traditionally, most cardiac research has been done on men, so this really skews everything toward them.  I'm going to take that article to my cardiologist (who is female) and show it to her the next time I have to have this crap done.

I'm so glad your heart is healthy; I know how very anxious you've been.  I hope you are feeling very relieved, but I don't blame you for feeling duped.  At least they didn't do anything more invasive to you!

[Jean]

Well, yes, I think I am okay. The Dr. said that my meds would take care of things for me. But, it is not a matter of feeling duped, altho, I do, it is a matter of, wow, I feel like they have been running me around the block for literally nothing. The stress of just waiting and waiting and dealing with the people in the Dr. office, who, in fact, are morons, wore me completely out. Not to mention, my kids were all worrying themselves to death also. Ah, well, a couple more days and I will be back to more normal again but I wanted everyone to know about this as if I had known earlier, this would not have happened.

[MooseMom]

"Duped" was the wrong word as that implies someone purposely tried to deceive you.  It does go to show, however, that too many people in the health profession seem to conveniently forget that people get stressed and worried.  You deserve an explanation from your doctor and a chat about cardiac differences in men and women.  Anxiety has been, for me, the very worst part of CKD so far.  I'm glad you posted about your experiences so that the rest of us can be a bit more prepared.  Thanks!!

[kitkatz]

If you are on the larger size the fat gets in the way of the nuclear tests sometimes.

[Jie]

Well, I passed two stress tests and just failed my third stress test. The transplant center wants me to have coronary angiogram test, of which the risk is a concern. I hope that the chemical will not wipe out my little residual kidney function.

[Jean]

jie, some one posted just yesterday that the medication given to you to take 2 days before and 2 days after is supposed to protect your kidneys, but, now, they have found out it does not.I dont yet know what, if any damage was done to my kidneys, but will find out on Dec. 2nd and will post it then. The name of the medication is Acetylysteine.

[Jie]

Thanks Jean. Where is the post related to Acetylysteine? I heard that a dialysis right after the procedure may help protect the kidney function.

[Jean]

I have heard that too, that dialysis after the test protects the kidneys, but, since I am not on dialysis, I am not sure. The post on that nasty medicine was on new posts just a couple of days ago. I think it was done by Right Side. I will look also.

[Stoday]

Visipaque was used in my angiography because it minimised nephropathy.

Interestingly I first had angiography, followed up by the stress test as part of a myocardial perfusion scan.

[Jean]

Well, I had a visit to the neph today. My GFR did go down, but only 2 points. Of course at this stage, 2 points is a lot. Still, I am at 22 now, so that is not too bad. A lot of stress and worry for next to nothing. Bun and Creat are up just a point of last time. I guess that is "normal" for this stage of the game.

[rsudock]

Jean this just goes to show that medicine is not an exact science and doctors are just giving us their best educated guess. A discussion my fave nurse and I had recently....

so sorry for all the worry you had to deal with. it sucks feeling like the sky is falling. glad everything is ok though.

xo,
R

[GraphicBass]

I am sorry that your doctor did not communicate better with you during your experience. Many doctor's seem to forget that patients are humans before they become fodder for medical procedures.

My wife and I have learned to be extremely aggressive in seeking information and asking questions. And I have been know to pester the doctors during procedures to understand what they are doing to me.

I've had 11 angiograms (5 resulted in angioplasty) and several stress tests (chemical kind), so I have some experience in this matter.

The stress test is only a very general guide to blood supply to the heart, and sometimes can only indicate a need to investigate more fully, usually with something more invasive, such as an angiogram. It can be affected by a number of things, so many cardiologists use it as a first step. Many cardiologists are somewhat conservative in prescribing procedures and start with the least-invasive ones first. Other times, insurance coverage mandates what tests can be done in what order. Still no excuse for the lack of discussion.

The opaque dye that's used in angiograms can be very destructive to kidneys, as you know, and can drop function or cause failure in those with CKD. My cardiologist stressed mightily about finally "killing" my kidneys, but as my nephrologist said to me once, "we can deal with kidney failure, but not with a dead heart." Blunt, but true.

Fortunately, there are ways to minimize the impact of the dye:

1. Use a very small amount. The last angioplasty I had the cardiologist used 1 gram of dye, which apparently is considered a tiny amount.
2. You can be given Mycomist before the procedure and after, which helps to protect the kidneys. It tastes like rotten eggs, but is not too bad when mixed with juice and taken quickly. DO NOT hold it in your mouth; swallow all at once!
3. You can also be given sodium bicarbonate, in my experience, as an IV. This is also a protective measure.

Since I was usually hospitalized for angios, they pumped my full of #2 and #3 for three days afterwards and minimized the drop in my kidney function for more than three years until they finally failed (not due to dye, just the progression of the disease).

It's wonderful news that you need no further intervention. Try to change the frame with which you view this experience: rather than be angry at the process, see it as a journey, albeit unpleasant, to a great outcome.

But then, I tend to see the "sunny side" of everything that happens to me....

gary