Should a patient submit to a nuclear stress test without having any symptoms to suggest the need for one?

Question

Having been diagnosed with white coat syndrome, the doctor suggests a nuclear stress test. Being trapped in a doctor's office, where blood pressure readings are highest doesn't seem to be an answer to lowering blood pressure readings. Readings out of the doctor's office, including the blood bank, are in normal range. Why is a nuclear stress test indicated. An echocardiogram was done earlier upon which the cardiologist diagnosed white coat syndrome.

Suggesting that one "protests too much" is sort of the sarcastic comments one expects from doctors...the type that take four visits to NOT get a TB test done properly.
BP IS monitored on a regular basis but the BP has only been high in doctor offices.
The cardiologist suggesting the test also states that he does NOT expect to find anything different than before. His polite comment was that "to calm down in doctor offices, you probably need prozac"
I would like to meet ONE doctor that seems to care about the patient, and READ the reports in the patient file.

I guess it was a good question. It is still in clinical review and the health insurance will not pay at this point. They want to know the need for this particular $2000. test as opposed to other possible tests.

Answer 1

A nuclear stress test is a regular treadmill stress test. The nuclear means they inject a "dye" into your veins so they can see the function of your heart better. Some of the answers here referred to a chemical stress test; that is not the same as a regular nuclear stress test.

The thing about white coat syndrome is that your blood pressure does rise when you're under stress. You may think it only occurs when you're in a doctor's office, but what about when you are in other stressful situations? Going to the blood bank, sitting at home, taking a BP in a drug store aren't stressful for most people. That BP doesn't measure how you respond to physical or emotional stress.

If your echo was normal (strange diagnosis of 'white coat syndrome' from an echo; I've never heard that diagnosis from an echo-c), and you are having absolutely no other heart symptoms, you could probably get away without the stress test. However, if your BP is consistently high in the doctor's office, your doctor is correct in order further testing.

Of course it is your right to refuse, which your doctor will duly note.

Answer 2

I don't think a nuclear stress test is warranted at all in this situation. It would be different if you had a consistent high blood pressure reading or if you were having some kind of heart palpitations or racing pulse. However, with a normal blood pressure reading at all times - outside the doctor's office - I think the cardiologist was correct in his 'diagnosis' of white coat syndrome. You might, however, want to get a second opinion, because we can never be too careful. And, I had a nuclear stress test and I HATED it. I thought I was going to have a heart attack when they did the injection to make my heart race. It was a horrible feeling.

Answer 3

From what you've said there is virtually no indication for doing any sort of a stress study - nuclear, treadmill, or any other type. In fact if you look at the likelihood of getting a false positive in a population group that is at very low risk then you are bound to accomplish significant medical misadventure - testing begets more testing or procedures - all unnecessary.

Given that every cardiologist knows this, there almost certainly is some other risk factor, EKG changes, family history or constellation of symptoms that your doctor picked up on that puts you in at least moderate risk. The stress test is designed to segregate those who have a moderate risk or symptoms - is this a definable region of ischemia or not. If it is, it warrants getting the blockage fixed.

Lastly, I got the sense that 'thou dost protest too much.' You almost seem defensive about your blood pressure. The question about white coat hypertension is - how many other types of mild stress situations cause your b/p to elevate throughout the day? It might make sense to either adjust your lifestyle (start exercising) or consider medication if your doctor thinks you need it - even if your pressure is not elevated all of time. Hypertension can increase risk for stroke, heart attack, kidney failure, and eye problems.

ADDENDUM

I have no professional relationship with you. So I have the benefit of being able to tell you as I see it. You clearly display anger toward medical people - ask yourself why - it is not in your best interst. My intent was to provide solid, free advice (which is based on my not caring, according to you) and you attacked me in return. Based on our brief interaction, you probably are going to do what ever you want.

If it has a bad result, please remember to be accountable for your own actions - as its been my experience that when something goes wrong with someone like you - its because the medical people were too incompetent and uncaring - not that you didn't follow ernest advice. I wish you well.

Answer 4

I don't know what white coat syndrome is but my 3 yr old son had open heart surgery 2 yrs ago. He has had to undergo lung perfusion scans to ensure that oxygen is reaching all parts of his lungs. It's just a more in depth test to help diagnose problems. Your doc may have other reasons for the test, too. You should take your concerns to the doc.

Answer 5

Should I have both Echocardiogram and nuclear stress test

Answer 6

Have you had ECG done? what about something called 24 hour ECG monitoring (also known as Holter)? Usually Thallium (nuclear)stress test should be done anyway before going ahead with for example an electrophysiology study, but of course ECG should be done too.

Answer 7

I would not take that kind of test myself unless you are unable to take a regular treadmill test . That is usually the reason for suggesting the test. It is a very expensive test and it actually stresses your heart and is quite uncomfortable .
Start with asking your doctor why he is starting with this test instead of a treadmill test and go from there.

Answer 8

Nice thing about America is you do not have to submit to any medical treatment, if you are sound of mind, that you do not want to. If you don't like it, just say NO.