Clogged arteries not showing up on ecg, echo or stress test?

[borahae]

So earlier in the year, my father was sent to the cardiologist because of his symptoms. There he had an ecg, echocardiogram (heart ultrasound) and a stress test. However, the cardiologist said his heart was fine and there was nothing wrong with it.

My father continued to have his symptoms and so the cardiologist referred him to somewhere else where he did another test (im not sure what test he got) but results showed that two of his arteries were 50% blocked (sorry not too sure about correct terminology but something along those lines).

I'm am now wondering why this didnt show up on the ecg, echo and stress test? Is it because the doctor made a mistake, or can clogged arteries really not show up on these tests?

I also went to the same doctor for my heart and he said it was fine, but now I am worried if he might have overlooked something

[vinixxx]

Ecg, echo and stress test are not the right way to check for coronary arteries stenosis or another artery defects.

This can be done only with Coronarography (Coronary catheterization).

This is so called a "gold standard" for conditions related to coronary artery tree.

Echographia is designed to examine heart valves and heart muscle's condition (heart failure).

Ecg is the best for showing arrhythmias.

[84green]

Hi Borahae

I had an ECG which indicated possible ischaemia (artery blockages). In order to confirm this, I then had a CT cardio angiogram (a non invasive heart scan) that confirmed two blockages described as between 25 - 49%.

As Vinixxx has said the gold standard test is an angiogram where a small camera is passed into the arteries to actually see any blockages. This is done under local anaesthetic in a hospital cath lab.

An echocardiogram doesn’t look at the coronary arteries - it focuses on the structure of the heart itself.

An exercise stress test is a good test to indicate whether the level of blockages are effecting the heart when under stress but doesn’t of itself look at the arteries

I’m guessing that your father had a CT angiogram. It’s quite possible that with relatively mild ischaemia (ie 50%) the ECG and stress tests would have been clear.

In the absence of symptoms of angina, such blockages are likely to be treated by medication and, if appropriate, lifestyle changes.

So, the tests that look at potential artery blockages are an angiogram or a CT cardio angiogram.

Hope that helps.

[Hidden]

Not all narrowing of arteries shows up in test your father had done initially, though most do. It can be a bit hard to move forward in tests when these are negative. Thankfully his cardiologist did this with a good result in terms of a diagnosis.

If you have symptoms that might be a sign of a problem, chest tightness or pain on exertion, shortness of breath or feeling sick during excerise, then go back and see your doctor. If not the chances are in you case everything is fine and you just need to keep an eye on yourself.

[Tessie28]

Only an angiogram will give a correct picture. From personal experience with hubby.

[StupidDrugs]

I was found to have raised Troponin when admitted to a posh hospital in Borneo and was advised to see a doctor when I got home (actually I was advised to have tests there but, being stupid, I discharged myself). When I got home I was referred to a cardiologist who did a comprehensive echo, umpteen ECGs, a treadmill stress test etc and none of them showed any issues whatsoever (not the slightest twinge or missed breath). Indeed, I was formally discharged and told there was nothing wrong with me which left me feeling quite chuffed as several people in my family had had early heart attacks in their lives (so I had always assumed I had some heart disease).

A few weeks later another cardiologist rang me, said he'd heard my story, thought it was interesting and could he "have a look under the bonnet". I had a CT scan and was called back to the hospital to be told by the second cardiologist that he and his colleagues were "astounded" to see that my heart is "riddled" with calcium. I then had an angiogram and they found triple coronary heart disease but, other than a 70% block at the end of the circumflex, nothing too concerning and was stuck on a cocktail of preventative nasty (for me) drugs. Unfortunately the 'preventative' drugs proved next to useless and less than three years later I had had a MI and my 'other' narrowings had gone from mild to severe (RCA, LDA and D1 all 95-99%).

Long story short, as suggested by above responses, unless they look under the "bonnet" it is hard to be 100% sure that somebody has heart disease or not and if they have, how bad or restrictive the lesions/blockages may be or how fast they are progressing. Due to a lack of NHS resources it is impossible for everybody to have a CT scan or angiogram so they have to have some screening criteria which is probably where I and your father initially slipped the net. It is good that he is now in the system but, unless there were obvious and severe issues from the narrowing, in the UK they would not have done anything for a 50% blockage anyway beyond prescribing a cocktail of drugs (increasing evidence suggests that anything less than a 70% narrowing is not worth consideration of a physical intervention and can be managed by drugs - unless you are an oddball like me who gets all the side-effects of drugs without the benefits :/ ).

If you have personal concerns, your only options would be to be persistent with your GP and explain how your father's CHD was missed and this is starting to concern you or, for rapid piece of mind, have an angiogram done privately (albeit this is not the cheap option!).

Best wishes!