View Full Version : Any cardiac nurses out there?

05-16-2008, 10:50 PM
Well; on top of a rash of serious family illness in progress, I had a treadmill test today and was told, "This is a positive test, which means there is a high probability that you have coronary artery disease, and I recommend a heart cath and angiogram." I am a sonographer (former x-ray tech) so I am familiar with what this entails. Here is the thing: I have concerned family members urging me to have a second treadmill test at another facility--"the leads my have been loose or upside down!"

I work with OB/GYN docs (NOT cardiologists) and when I ran it by one of the docs I was advised, "No. Go get the procedure done. That is not a test that should be repeated when it is positive." I do understand the sensitivity stats (positive = 78%.)

The question: Is it possible that the test is positive because of technical error? Could a second treadmill test be warranted? I am a healthy 51 y/o female, nml cholesterol and triglycerides. However, my dad had an MI at age 51.

Any comments will be appreciated (and taken with a grain of salt :teehee: of course.)

05-17-2008, 12:04 AM
Well, it's always possible for a test to be wrong but it is also unlikely. That is why they want the angiogram, to verify the findings of the treadmill and determine the extent of the problem. It may be just an angio, or they may recommend at stint. Or they may recommend an open heart surgery...scary prospect. But if you don't follow up and in some future years have an MI which causes damage to cardiac muscle you could be in worse shape.

Heart disease typically presents quite differently in women than in men. Also cholesterol and triglycerides are not the only determining factors.

So there are my thoughts. I'm not a cardiac nurse. I'm a home health nurse but have done a bit of cardiac in the past and quite a bit of follow up. If it's any comfort to you I would be reluctant to have an angio too...it's hard to follow ones own advice!

Good luck!

05-17-2008, 03:09 PM
I'm sorry to hear about your test results.
My husband is going through the same thing. His stress test showed the lower part of his heart was sounding weak so he had an ekg this week and goes in for an angiogram next week and will be off work for 3 days. The cardiologist also wants him to record his blood pressure morning and night for the next week.

05-17-2008, 03:35 PM
I'd have the angiogram. When I was assisting with them, I swore to never have one, but now they are a whole lot easier.

And he's right, a second test is not a good idea if the first one is positive, that I remember.

Also, I can't think that the test would even look right with leads loose or upside down. The machines themselves would tell the techs there is a problem.

05-17-2008, 04:57 PM
Here are my 2 cents...I'd get a second opinion.

Yes, you appear to have a strong family history, but many of these tests have been developed for, and have their results based on, "the average male", whatever that is.

There are now many other non-invasive ways that you can have your coronary arteries evaluated.

It is at least worth looking into all of your options, to make a more informed decision (with your doctors) as to how to proceed.

05-17-2008, 09:45 PM
Thank you all for your comments. I am still considering how to proceed. Plantgodess, good luck to your husband.

05-17-2008, 10:10 PM
I used to be a cardiac nurse. The stress test can have false positives. The number of false positives goes up when a group that does not typically have heart disease is being tested eg. twenty year old women. You did not say whether you are post menopausal or not or whether there are other risk factors involved like diabetes or obesity. Family history in and of itself is a strong risk factor. A lack of symtoms does not mean that you have no heart problems. The Framingham study produced a large number of people who had MI's and didn't even know it. In addition, its well know that women have symptoms that differ from the symptoms that men have. If you do decide to have another, I would have a stress MUGA scan which reveals areas of the heart lacking in oxygen. If you decide to go with a catheterization I would have it done in a hospital that does it every day and which also has open heart surgery done in it. (One hospital near me relies on a helicopter if something goes wrong. I always wonder whether they do this procedure only in good flying weather).One of the risks of catheterization is puncturing the artery itself and the only way to fix that is bypass surgery. In addition, sometimes the need for a stent is immediately apparent and can be done right away in the right place. If at all possible, have it done at a major medical center. You can get the test results reviewed by another cardiologist and get his or her recommendation without further risk.
The best of luck to you.

05-17-2008, 10:12 PM
While I'm no medical professional, I'd say you should have the follow up tests just to be sure. If nothing else they'll put your mind at ease if they show nothing is wrong.

Better safe than sorry.

05-17-2008, 10:29 PM
Whoa, Jeremy! Thanks for the information. I am in good health: normal weight/BMI, no diabetes. I have a pretty good diet and have not eaten animals (except fishes: salmon) for at least 15 years. Still, I can't say my diet is impeccable. Is a MUGA scan a thallium perfusion scan, which I understand is more sensitive? If done, it will be at a reputable, large medical center known for heart work. I know the risks associated with angio. I am considering getting the stress ECG report and tracings to take to a different and recommended cardiologist for a consult, just as you mentioned. My docs refer to the cardiologists, so I hope they will make a phone call and get me an expedited VIP appointment. Thank you for your input. It means a lot to me.

05-18-2008, 12:36 AM
You're very welcome. :hug:. Thallium is what I was thinking about in terms of scans. The very best of luck to you. Keep us posted.

05-18-2008, 08:43 AM
I'm not a cadiac nurse, but I did stay at a Holiday Inn Express last night :teehee:
Anyway my question would be if you are healthy, what prompted your doctor to do a treadmill stress test and do you have baseline ECG's? Did you sit down and discuss the results with your PCP, the tech or a cadiologist?
For what its worth, when it comes to medical stuff if there is anything that makes you uneasy ALWAYS get a second opinion. A good doctor is not offended by you asking for more information. If nothing else it will help settle your mind which then makes the treatment that much more effective.
Good Luck

05-18-2008, 12:29 PM
I'm not a cadiac nurse, but I did stay at a Holiday Inn Express last night :teehee:

:roflhard: :roflhard: :roflhard:

Good one vaknitter!

Thank you for your expert and qualified advice. I have had fluttery feelings in my chest for years. Twice it has been investigated with by Holter monitor with inconclusive results because there were no episodes. (I forgot to tell Jeremy that I am premenopausal.) Your comments sound right on. I have pretty much decided (at least for this minute) that I will get the report and tracings and get another opinion. I was thinking I might consult with my PCP, but I think she will defer to the cardiologist (I work in this litigious doctor's world.)

05-20-2008, 10:19 AM
I have been a Cardiac Nurse for 22 years, 5 years in CCU, 13 years in the Cath Lab and I have spent the last 4+ years running a Cardiac Rehab program. If the Dr. recommends a Cardiac Cath HAVE ONE. A stress test can certainly show a false positive (or a false negative), although it is very unlikely that it is due to operator error (or lose leads).

Women are far more likely to die from cardiac disease than men. They have atypical symptoms and are much more difficult to diagnosis. You have a family history and you are at "the age" to have cardiac problems.

A Catherization is a very simple test, although it is invasive the risks are minimal, that will settle beyond a shadow of a doubt whether you have coronary artery disease. The fluttery feeling you have is unlikely related to caoronary artery diesease but more likely a benign arrhythmia (many people have them).

Have the Cath!!!!!!!!!!!!!!