Tests

[Yasyass]

Went cardiologist didn’t quite understand although he did try to explain about my mri results but said he recommends a nuclear stress test and Angio test I am very worried why I have to have these if I did a mri and says the angio cause heart attack or stroke risks I have no symptoms of hf but gp says meds and lifestyle change but even with these I could go worse so I am more worried

[MichaelJH Heart Star]

An angiogram is the "gold standard" if atherosclerosis is suspected. This is usually performed if a CT or MRI suggests an issues in this area. The idea of nuclear stress testing is to create two images of how blood is being distributed to the cardiac muscle—one during rest, and one during exercise. Normally, the blood should be evenly distributed to the heart muscle both at rest and while exercising, and the images will show this even distribution. If both the rest and the exercise images show a fixed patch of poor blood flow, that indicates that a prior heart attack has occurred. If an area of poor blood flow is identified during stress testing that is not present during rest, that indicates that a blockage is likely in one of the coronary arteries that is producing a transient drop in blood flow.

[Yasyass in reply to MichaelJH]

Thank you for such an informative reply and wondering how u know all of that I had a heart attack four years ago so it probably show but wondering what further treatment would be needed thank you

[MichaelJH Heart Star in reply to Yasyass]

Thank you for the compliment - I will come back to it later. As regards further treatment it depends on what they find. As they are doing an angiogram they probably suspect a blockage of some sort. Treatment for this could be conservative (i. e. lifestyle and medication), stenting or bypassing. Much depends on the percentage of narrowing, the number of arteries affected and which arteries they are. I had four 70% or more with the LAD at 85%.

How do I know so much - because I am interested. I was maybe fortunate that at the time when about 10% of the population went on to university I went to a primary school where 50% of former pupils went to university. This was followed by an excellent grammar school where unfortuneately the experience was spoilt by a toxic bullying culture. From there I went on to gain a BSc Physics, MSc IT and was made an Associate of the university eight years ago. I have worked in areas as diverse as composite materials for the aerospace industry (where I learnt a lot about imaging techniques) to medical sensors.

As medical issues have occurred through my life (Type I diabetes, PAD and CVD) I have made an effort to find out and understand them. My former GP (now retired) admitted I knew more about the diagnosis and treatment of PAD than he did. When I first attended the Urgent Chest Pain Clinic I saw various BHF booklets and picked up all the relevant ones - nobody else did! Since then I have read various books on the subject but am not up to speed on ECG interpretation and MVA.

[Milkfairy Heart Star in reply to MichaelJH]

Michael I'll send you a tutorial on MVA and Vasospastic angina 😉

[Heythrop51 in reply to Milkfairy]

I think MichaelJH and you should be awarded the title of Honorary Cardiologists. Your knowledge is awesome!

[Alessa69 in reply to Milkfairy]

Could you send the Microvascular Angina tutorial to me as well please? That would be SO, so helpful

[MichaelJH Heart Star in reply to Alessa69]

There is an exam after! 😀

[Milkfairy Heart Star in reply to MichaelJH]

I would love to get MVA and Vasospastic angina into the Cardiologist's professional exams......working on it😉

[Milkfairy Heart Star in reply to Alessa69]

Have you had a look at the information on the BHF website about MVA and vasospastic angina?

[Frenchbulldogsx in reply to MichaelJH]

Your brain is a sponge. Mine is a sieve..... Your so lucky that you retain so much ❤️. Very informative and a great comfort to us

[Lezzers in reply to Frenchbulldogsx]

Completely agree, that's a posh "ology" he's got there as well!

[Frenchbulldogsx in reply to Lezzers]

Excuse me I will have you know that I have my cycling proficiency badge 😜

[Lezzers in reply to Frenchbulldogsx]

I got a gce in art.....oh wait a minute that wasnt me, that was Rodney!

[MichaelJH Heart Star in reply to Lezzers]

Like Rodney I have GCEs in Art and. Mathematics! Plus a few others! 😀

[Heythrop51 in reply to Frenchbulldogsx]

I have got one too!

[MichaelJH Heart Star in reply to Frenchbulldogsx]

Snap!

[marigoldb in reply to MichaelJH]

Like others, I learn so much from your answers to a lot of our questions. Yes you need a degree awarded in Heartology 1st class honours!

Always good to have another ology! Best wishes.

[Alison_L in reply to Frenchbulldogsx]

Frenchbulldog, I have cycling proficiency PLUS a 10 yard swimming certificate. Not with a bike.....

[Handel in reply to MichaelJH]

Certainly think you should have a doctorate in heart stuff! xx

[Modeller3]

Hi just had all of the all thow I have hf don't have any blockages in the rest of my heart , which is good

Good luck and worry

[Yasyass in reply to Modeller3]

Cardiologist said mri not clear not know if any blockage but heart damage from ha before but not know extent I thought mri would show a clear pic and see wh further treatment would be needed all this stress causes me to have slight chest pains whereas I didn’t have any symptoms before I had tests done

[Sunnie2day]

I can understand your concerns, especially about the angio possibly causing you to have another heart attack - it is one of the risks of the procedure BUT it is a very small risk and where better to have a heart attack than right there in a hospital setting? If something happens they're on-the-spot to sort it.

When I signed the paperwork for my recent (November 2019) angiogram I was told of the potential for heart attack and or stroke as they would be 'stressing' my arteries to see what might be causing the problem. They were careful to explain doing that stressing would give them answers they couldn't get any other way, and if the stressing caused a heart attack and or a stroke they would be able to sort it immediately. In the end I realised that was a better option than taking my chances out on the pavement or home alone where if I had a heart attack there might be no-one to find and help me.

Here's something to hold onto, YasYass - if you were in a serious condition you would be in hospital right this minute awaiting intervention. You're not, you're home waiting for the bookings notifications letters to come through the door

And hopefully your GP is correct - if proved by the tests the cardiologist wants to fully investigate your situation, you may very likely only be looking at lifestyle+medication. Definitely doable - but don't forget, if more invasive interventions are needed you'll be in the perfect place to get those done quickly and with reasonable expectations of a good outcome.

It's hard not to worry and even harder to keep yourself from working yourself into a right panic state (anxiety attacks, I do not recommend them!). Keep reminding yourself you're in excellent hands and are being well-served by a conscientious medical team dedicated to getting you back to the best health possible - reminding myself of that got me through the weeks of waiting for the tests and it can get you through as well.

[Yasyass in reply to Sunnie2day]

Thank you for your reply just wondering I had a mri recently wouldn’t that show anything instead of angio and when u did the angio did you have any symptons

[Sunnie2day in reply to Yasyass]

It's my understanding a cardiac MRI, while an exceptionally good diagnostic tool, is not quite as good as a full-on angiogram. The MRI is very, very good, but the angio is considered even better, if that makes sense. Also, I think the MRI shows some things but not others while the angiogram shows everything (except microvascular angina and vasospastic angina, I think - Milkfairy is the expert on that one, I'm just an interested bystander on that so I could be wrong).

I was booked for a cardiac MRI, got there that morning and was told by my cardiologist I'd been bumped for an emergency patient. He then told me after looking at everything again whilst waiting my arrival, he wanted me to agree an angiogram instead as it gives more of the information they needed in view of my symptoms (angina on exertion and symptoms of constrictive pericarditis as a new complication of the acute flare of my recurrent pericarditis).

It took three weeks from the cancelled MRI to the angiogram being performed on 20 November 2019. The results showed no blockages at all and no constrictions when stressed - but apparently it did show I was still in an acute recurrent pericarditis flare including pericardial effusion.

Which surprised all of us considering I was beginning to feel great again with far fewer angina attacks and we all thought I'd shaken the flare off. They then thought about booking me for that cancelled MRI but are 'rethinking' that and now it may just be another echocardiogram to see how much pericardial effusion I've still got, if any by the time I get back up on that table.

About the only symptom I have now is a persistent wheeze (typical for me when I have pericardial effusion) - once a week I present myself to the practice nurse at my GP surgery and she listens for 'pericardial friction rub' to see if the flare is finally gone. The last two weeks she hasn't bothered to slap the stethoscope on as she can hear the wheezing when I come into the room

But I'm honestly feeling better every day - not a lot, and not all at once, but I am seeing improvement.

You next

[Milkfairy Heart Star in reply to Sunnie2day]

Great answer Sunnie2day!

An angiogram with acetylcholine only done in a few places in the UK will detect vasospasms causing microvascular and vasospastic angina.

That's how my Coronary vasospastic angina was confirmed.

The newer MRI scans can detect some types of microvascular dysfunction causing microvascular angina due to the small vessels failing to dilate.

[Prada47]

Hi Yasyass

The Gold Standard for Testing is a Nuclear Profusion Scan under Stress.

Now I was told that by a Consultant Radiologist less than 2 weeks ago, It is a difficult test to interpretate but it is very very accurate. He also said not many Hospitals have the facility to carry out and read the Test. I was talking with him about Ejection Fraction and he said this is the most accurate of MRI or Echocardiogram etc.

Sorry missed one which is referred to as a MUGA scan which is also very accurate test

Regards