When do you need a heart catherization? How do you know if a doctor is doing unnecessary tests?

Question

My 49 year old smoking, drinking, coffee addict husband went to a new neurologist for cluster headaches. The doctor noticed his heart had an irregular beat. Said it was probably nothing and sent him to md for a ekg. The md did ekg and said it was probably nothing but sent him to cardiologist. The card gave him a stress test which he passed without even a sweat but noticed his heart did dip down on the monitor. (like some beats up one beat down, etc) So he started talking about doing a heart cath and possibly putting in stints. My husband feels fine, his headaches are gone. When they called to make the app. for the heart cath. I asked if it could be done on another day. The nurse said (altho this doc has about 12 associates) that "he" wanted to do the heart cath because he was familiar with the stress test. Alarms went off, this could be unnecessary surgery. My girlfriend has pvc and it sounds like the same thing. Too much caffeine, alcohol, lack of sleep. What to do??

Thank you for all your polite answers. I won't say anything about the rude answer. We live in the US and have learned to doubt our doctors. They like to do tests and surgeries. You need to be well informed. I didn't go with him for the test but from what he tells me the doctor was stumped as why the heart dipped. He said the dips could mean his heart was reaching for energy. Also he was not instructed to refrain from drinking or eating before the test. (which I am told would have been the norm) I would have felt better if the test were done in the hospital under no specific doctors care, because it was done in the doctors office with nobody else to check up on him,and he specify he do the heart cath.. This all seemed odd. I am going to make an app tomorrow with my doctor for him, I will go with him to this app. I might add, he is not overweight, and is very active. His family are all smokers and they seem to live fairly long lives. His mother is 76. No info on dad lately.

Answer 1

What do you mean by some beats up and some beats down? your cardiologist should explain it to you clearly. Irregular heart beat (PVC, APC) and ST depression are different. If its 'ST Depression'-it means yes, he has blockages. If its irregular heart beat (the PVC's , APC's);its his heart nerves, not his arteries. Nerves and arteries are two different things- you should take note on that.

I should tell you that treadmill stress test are not 100% accurate too. The accuracy is up to 80% only. The MOST accurate test to detect a heart disease id by coronary angiography (catheter)
Your husband are a smoker, a drinker, and consume a lot of caffeine. He is in the higher risk of getting heart disease. If he has hypertension, family history, high cholesterol, overweight or doesnt exercise regulary-his risk goes up even more than double.
I will adivse you to bring your husband for cathether. Its an almost painless procedure, its under local anaesthetic and will be over within 30 mins only. Afterwards, you can out your mind to rest. The risk for this procedure is also very little-its a safe procedure if you have a competent cardiologist.

Ur husband is in the bigger risk to get heart disease, thats why the cardiologist ask him to go for cathether (coronary angiography).
Im a cardiac technologist in the hospital, i hope my advice will help you

Answer 2

jdevanus,

You do not want to wait.

The time to get an angiography is before the damage is done. An angiogram is minimally invasive and a very good help to diagnosis. While your husband feels fine now, it's because he's not being stressed. When did the ekg show a problem? During the stress test, right? That means that there is an insufficiency in the blood supply to his heart when he needs it the most. This will only get worse, and that means that, though he feels fine now, he's headed for a heart attack. It's only a matter of a short time.

Remember, symptoms of such ischemia (insufficient blood supply) don't show up until the blockage is severe, usually over 80%. He's in danger.

Be thankful that your doctor(s) gave him a stress test, that this showed up while he's still healthy, and something can be done about it now.

Remember, they didn't try to get him to do unnecessary tests or surgery. They went step by step, doing exactly the right thing, to find out just what his condition is. The next step will be the angiogram. That will tell the doctors just what arteries are narrowed and where the narrowing is, and they'll do it BEFORE he has a heart attack.

Please remember, you have only two alternatives: this angiogram, or a heart attack.

You do not want to wait. Get the test now.

Please. Your husband's life depends on it.

Answer 3

I'd ask some more questions. Sounds like he had some ectopic beats (the one up, one down, pattern on the monitor) which are common and can occur in healthy hearts. What you need to find out is whether there were any signs of cardiac ischaemia on the stress test (reduced blood flow to the heart muscle). It sounds like there may have been, as the cardiologist spoke about stents. This might be an indication for an angiogram (cath) though not sure why it has to be that doc who does it. Any cardiologist could interpret the stress test, though that pretty much becomes irrelevant at the time an angio is being performed. Don't waste time, though. Smoking does increase your husband's risk of heart disease. . .

Answer 4

This is a procedure done on the heart. In it, a doctor inserts a thin plastic tube (catheter) into an artery or vein in the arm or leg. From there it can be advanced into the chambers of the heart or into the coronary arteries.

This test can measure blood pressure within the heart and how much oxygen is in the blood. It's also used to get information about the pumping ability of the heart muscle. Catheters are also used to inject dye into the coronary arteries. This is called coronary angiography or coronary arteriography. Catheters with a balloon on the tip are used in the procedure called percutaneous transluminal coronary angioplasty (PTCA). Catheterization is also done on infants and children to examine or treat congenital heart defects. No medical test is uneccessary. With the current state of the NHS they usually take care of the way they spend money. A Cardiac surgeon will carry out the catheterisation but apart form a small prick when the catheter is inserted there is no pain whatsoever. In fact the whole procedure is quite entertaining as you are awake throughout and can watch the arteries in and around your heart pumping away on a screen. In fact it is much better than Casualty or ER. Tell your husband to stop prevaricating and get checked out before he has a heart attack for real.

Answer 5

Thirty years ago doctors had fewer tests and less knowledge about heart disease. About 2% of patients having a heart attack were sent home from the emergency room, because the tests available, the history and physical exam made it extremely unlikely that they were having heart problems, despite the fact that it turned out that was exactly the case. With a much better understanding of heart disease, and many more available tests, that percentage has dropped to about 2%. That's right, no change, except that the court judgments in that 2% have grown exponentially. People are complicated, and there's no "right" answer. If you have an advanced degree in math, with a thorough knowledge of statistics, you can get a good idea of the risk-to-benefit ratio, but normal people have no recourse but to discuss things with the doctor and trust (or not trust) his judgment.

Answer 6

Wow. He DOES need this, just based on what you said about all his bad habits and test results. A heart cath is NOT a big deal. They just want to look at his arteries. The alarms that SHOULD be going off for you AND your husband are "OMG....something is wrong and he better get this test before he keels over from a heart attack and then has to have a quadruple bypass."

Now that IS surgery and can possibly be avoided just by having this done. Don't put it off.

Answer 7

Well, as long as you're happy that's all it is, you can console yourself with that at his funeral....

It's a great saying in Ireland, "Well, at least nothing serious killed him in the end"....

Doesn't it occur to either of you that he fits many of the criteria for heart attack and heart disease??? Male, middle aged, smoker - all he needs is a positive family history and either high blood pressure or diabetes to increase his odds.

If the tests were not being done, you'd probably be the first one to complain if your husband had a heart attack.

Give me strength......

Answer 8

doctors dont waste time on unnessesary test he must need it but if you dont think so there are hundreds will take his place i can only say to you be grateful they are dealing with it how they know how I've been there and had major heart surgery and i'm very grateful to those wonderful surgeons they have so far given me 6 years extended life and still,feeling fine

Answer 9

usually heart cath are done to patients with abnormal ekgs or other diagnostics that indicated somethings wrong with the heart. you could always go to another cardiologist of your choice for a second opinion. Even if ur husband is asymptomatic, it doesnt mean thats nothing's wrong.

Answer 10

Symptoms of ischemic heart disease or abnormal stress test.