2nd Angiogram needed

[Manhattan1]

last week i posted that Cardiologist has arranged an angiogram at Golden Jubilee hospital.. this after having a CT angiogram in April that resulted in mild/moderate plaque in LAD.. Cardiologist informed me in August that one of his colleagues was going to have a a second look at original CT angio.. obviously something wasn’t clear or something else showed up..anyone else been in this position and had to have a more invasive angiogram!

[istimewa]

Hello Manhattan1,

I was 1st recommended a CT angio which showed moderate disease in the right coronary artery (RCA) and severe disease in the LAD artery

Then, I was recommended to have a cardiac MRI - this looks at the heart tissue (instead of the coronary arteries themselves) and shows up which areas have ischaemia (inadequate blood). It showed that the tissue around the right coronary was severely ischaemic whilst the tissue around the LAD was only moderately ischaemic.

So, the CT angio indicated my problem was worse in the LAD than the RCA. Whereas, the MRI indicated my problem was worse in the tissues supplied by RCA than those supplied by the RCA. In other words, the 2 tests were not consistent in saying which was worse.

The cardiologist informed me that the cardiac MRI is usually more accurate in reflecting the true situation, than the CT angio. They offer the CT angio first because it is usually a cheaper test than the cardiac MRI.

But both these tests, if shows up any disease, will finally need to be confirmed by the gold standard test, which is the invasive (traditional) angio. This is the most accurate to document the presence of disease in the coronary vessels, and to accurately determine the severity of disease too. It is a procedure where the wires are threaded from either the wrist or groin, into the heart vessels - by doing so, and actually being present inside the vessels of course it enables the most true assessment/confirmation of disease within those vessels.

IN my case, the invasive angio tallied with the findings of the cardiac MRI i.e. my RCA had severe disease almost 90% narrowed by disease, whilst my LAD had moderate disease. So, it confirmed what my cardiologist said, that the cardiac MRI is usually more accurate than the CT angio.

Of course, if we think about it, the CT angio is like trying to look at the heart vessels from outside (e.g. peering thru the bedroom window to assess the redecoration job needed for the bedroom). Whereas, the invasive angio is like being inside the bedroom and directly looking at the condition of the room that needs the redecoration job. One can assess the redecoration job far more accurately when one is standing inside the room and directly looking at the condition of that room. Trying to assess the condition of a room from just peering through the bedroom window from outside can only produce a rough quote for the redecoration job, not an accurate quotation!

So, if your original CT angio pictures are being shown to another pair of eyes to interpret, this is akin to asking a different builder to come give another rough quotation for the redecoration job by peering through the same window from outside. He may/may not end up giving a same/different quotation as the first guy. But the only way to achieve a really accurate quotation is to allow the builder inside the room in order for him to see close up and accurately assess what decorating work would be required i.e. an invasive traditional angio, which continues to be the gold standard test

Sorry for the long winded explanation. But if you made it this far, I hope it helps you to understand what they may achieve by asking a different specialist to look through your original CT angio images!

[Manhattan1 in reply to istimewa]

that was a great explaination!!.. many thanks.. i’m actually happy that i’ve been referred for the ‘gold standard! angiogram.. at least i should have a definitive result on any other problems that exist apart from the already diagnosed LAD problem

[istimewa in reply to Manhattan1]

Oh its good if you're proceeding to have an invasive angio coz it will fully and definitely confirm where disease is present, and grade the severity of narrowing in the vessels with disease for you

However, it still would be interesting to see what the colleague has to say regarding the original CT angio images, and compare it with what was first reported. You'll then get an idea how the images from the non invasive CT angio can lead to consistent or discrepant interpretations between different colleagues within the same single specialty

[Manhattan1 in reply to istimewa]

hope you

don’t mind another question.. i have CKD stage 3b.. lowest gfr was 29 just before the CT angiogram.. Consultant put me on an IV to get the figure higher before the scan and put me back on it afterwards to flush the dye out of my system.. will this be repeated before my angiogram.. or will blood be taken beforehand when i go into hospital?.. at the minute my gfr ranges between 30 and 33.. thanks

[istimewa in reply to Manhattan1]

I'm not sure that in the angio they employ the same dye which was used in the CT angio.

The radio opaque dye used in the CT angio relies on being eliminated from our bodies via our kidneys. Hence, your gfr has to be a sufficiently healthy level.

But I'm not sure that same dye is used during the gold standard angio. Sorry you'll need to ask the cardiologist. My bet is that it's a different dye that doesn't depend so crucially on the kidney gfr

[Manhattan1 in reply to istimewa]

thanks for getting back to me.. will wait for appointment letter and make enquiries 👍

[Manhattan1 in reply to istimewa]

received a letter from local hospital today.. not expecting one..appointment for Echocardiogram 28Nov.. don’t know who ordered it.. maybe that’s a normal thing before an angio?

[istimewa in reply to Manhattan1]

Echocardiogram isn't a standard pre test before an angiogram usually. A cardiologist can order an echocardiogram whenever it's considered additional info could be generated, (and if said additional information would help towards the angio).

By right, you ought to have been informed the reasons/purpose of getting you to undergo an echocardiogram, whether or not it's to preceed the angio

[Manhattan1 in reply to istimewa]

will call GP and find put if they know anything about it .. thanks

[istimewa in reply to Manhattan1]

Correction regarding angio - My bet is that it's a different dye that DOESN'T depend so crucially on the kidney gfr

[Manhattan1 in reply to istimewa]

phoned GP surgery.. receptionist said angio letterfrom Cardiologist to GP received 22 Aug.. will get copy tomorrow.. gist of it.. after reviewing the CT angio again they have requested Coronary angio at Jubilee hospital.. no letter regards echocardiogram received by GP

[istimewa in reply to Manhattan1]

So it's unclear who has recommended the echocardiogram to be done on you! So, it's a mystery as to what purpose would be to get a echocardiogram, what useful info would be anticipated from doing the echocardiogram. You could contact the sender in the hospital (or relevant department) to ask which doctor requested the echocardiogram

[Milkfairy Heart Star]

Hi Manhattan

Golden Jubilee is one of the few places where they perform more detailed angiograms to not only look at permanent narrowing of the coronary arteries but also how well the small microvessels work.

Microvascular dysfunction which can cause Microvascular angina.

Also they asses for vasospasms in the micro vessels and coronary arteries- vasospastic angina.

During an invasive angiogram they can assess how well the blood flows through your coronary arteries and this helps guide the Cardiologists how to treat your symptoms best such as a stent or medication.

[Manhattan1 in reply to Milkfairy]

many thanks Milkfairy😊