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My dr wanted me to get one 2.5 years ago because my cholesterol was high which I am now on meds for. This was my results:
Resting Echocardiogram: Normal LV systolic function with no regional wall motion
abnormalities. Limited color flow is unremarkable.
Post-Stress Echocardiogram: Appropriate augmentation of all LV segments with no
exercise-induced regional wall motion abnormalities.
Conclusion: Normal stress echocardiography
No symptoms and exercise everyday but went for the test that cost $1100 even with insurance. She said there were a couple of lines on the EKG that she wanted to check that were “probably nothing” so had me do an echo at the office that was normal and then the stress test at the hospital.
Now my blood sugar is elevated so she wants me to get another stress echo. Working on getting sugar down. Still exercise everyday. She is extremely thorough. Do you think I need to go for another stress test? Can things change a lot in 2.5 years?
It sounds like she's trying to re-coup the expense of buying an echo machine for the office. A stress echo can only tell you that you have scarred or less functional muscle tissue as opposed to normally functioning muscle tissue. It doesn't tell you why it's not functioning normally. It's more usual to order a nuclear scan with the exercise test if you want to find artery problems.
It's recommended that stress tests be done for screening purposes on anyone with at least two positive risk factors for CAD (strong fam hx, HTN, hi chol, smoker or DM). It's also ordered if a pt presents with a new symptom consistent with the possibility of CAD- chest pain or unusual shortness of breath on exercise, new dysrhythmia or new EKG finding suggesting "silent infarct."
When to order a second test after having had a normal test if nothing new has happened is a question without a scientific answer. Obviously people with bad coronary arteries had normal ones in the past. When did they change? ….Nobody has studied the appropriate timing of repeat stress tests for screening purposes (ie- when no new symptoms have come up).
In your case, hi chol was the only risk factor and a stress test probably shouldn't have been ordered in the first place. Now, with hi BS apparent as a second risk factor, it should be ordered-- but it was already done. So we still don't know what to do.
If I were you, I would at least put it off for a while, particularly if you are completely asymptotic and it is going to cost you over a thousand dollars. I would tell my doctor that I am going to try and get my blood sugar down and will consider having the test if I am unsuccessful.
Another thing you could do is ask your doctor more questions: What exactly will you be looking for in the echo? How likely is it that there will be some abnormalities? Which particular abnormalities would you expect to find given my past echo results, my high blood sugar, my lack of symptoms, etc.? Why are we looking for these potential abnormalities? Is this going to effect the medication you prescribe or my treatment in some other way?
If you get the “you never know” or “it’s hard to know in advance,” answer, you can say that scientific inquiry (OK, not really science here, but hopefully not completely unrelated either) involves hypothesis. Scientists just don’t engage costly experiments to see what’s up, they have a motivating idea and motivating expectations. Similarly, if you are going to get a costly and time-consuming exam, you need to have some idea in advance of exactly what they are looking for, how likely they are to find it, as well as the importance of finding it or not. Even if a doctor is pretty sure they are going to find a specific abnormality on your exam, but finding it isn’t really going to effect your treatment in any significant way, you need to know that in order to make the right decision for you.
Per my results above would more test be ordered at the time? Or does it show there was no need for additional testing. I remember them telling me the stress test doesn’t show if there are clogged arteries but they can tell there are by abnormalities in the test. The stress test wasn’t bad it was just hard at the end when you have to hold your breath for them to do the scans after you got your pulses up to 160.
I do stress echoes, and work in a private cardiology practice.
Based on your story, I would say no, you do not need a stress echo. Although I make my living at doing echoes & stress echoes, getting either one done prophylactically is a waste of money.
I would either say no thanks or at least get a second opinion. This sounds like either she wants to cover her you know what in case you do develop heart issues in the near future or is just being overly careful. Either way it doesn't sound right. This is like a cardiologist here that, if there was even one situation in your past indicating some heart concerns would insist before you have any kind of surgery, you have an angiogram. (spelling) I know 4 different people who went though this including myself. Of course in all 4 cases
there was no reason for the tests, not to mention he wanted all to have a chemical stress test as well as several other things. He is still somewhere in the area but not located where he was and I know of no one who uses him anymore.
I've had an MI caused by coronary artery disease (100% blockage). The only time a doctor has asked me to take a stress echo was when my cardiologist requested it (post-MI) after a regular stress test was marginal. He said "for most folks I wouldn't bother, but with your medical history let's be safe." The test was negative, by the way.
My general practitioner has never requested one, even tho I had high blood pressure and marginal cholesterol. The one stress test he had me do was less than 2 years before my heart attack, and it was negative.
I've had an MI caused by coronary artery disease (100% blockage). The only time a doctor has asked me to take a stress echo was when my cardiologist requested it (post-MI) after a regular stress test was marginal. He said "for most folks I wouldn't bother, but with your medical history let's be safe." The test was negative, by the way.
My general practitioner has never requested one, even tho I had high blood pressure and marginal cholesterol. The one stress test he had me do was less than 2 years before my heart attack, and it was negative.
A stress test with nuclear scan has a sensitivity (ability to spot disease) of a little less than 90% and a specificity (ability to exclude disease) about the same. The stress echo isn't quite that good, but pretty close.
Your negative test 2 yrs earlier either meant you were one of the false negatives that are unfortunately just statistically unavoidable, or it means that you "crossed the line" of disease progression during that 2 yr period.
I'm not sure of the wisdom in doing a stress test (except for purposes of exercise prescription) AFTER we KNOW you have had significant CAD-- only an angiogram can give us the info we need to see if you need more stenting or bypass surgery at that point....Do you know the joke about the "eastern European guy" who keeps losing money at the bar betting on the instant replays?
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