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Hi, posted last year about heart palps 5 months postpartum. Long story short was checked out fully - echo, monitor then a nuclear stress test that gave a false positive and was sent to have a heart Cath. Palps were benign in the end, just bothersome. However.. 15-20% blockage was found in two arteries. I was told I have heart disease and was given a year follow up appt.
Quick bit about me, 33 female, not a smoker or drinker, not athlete but not sedentary either, vegetarian for many years and mostly eat well. BP and cholesterol checks are always good. Thing is I have one major risk factor which is family history. My dad and his dad has had triple bypass(in their upper 60s) and other grandpa died of heart attack in his 40s. Of all the siblings(who are alive in their 50,60,70s), only my dad has had a heart problem as well but that sure doesn't make it look good for me.
So went to appt and when I told my doctor about my dad(as his bypass just happened in April) he was more concerned. He wanted me to start a statin and daily baby aspirin and have biyearly nuclear stress tests. I'm all for prevention and am concerned to about my family history. Only concern I had with the plan - which I thought of AFTER leaving appt was about the exposure to radiation every other year(from nuclear stress test). Seems like an awful lot but I also don't want to skip out on preventive tests. I already know I have some sort of blockage and prefer to do what I can to minimize a heart attack.
Anyone else have these for prevention? I can ask at my next appt but it's months away and would like to hear some experiences or info anyone may have. Anyone else with what they consider mild heart disease? Do you do anything for prevention?
It sounds like it's consistent with the standard of care.
"If you’re at an elevated risk but haven’t been diagnosed with heart disease, had a normal reading on your recent nuclear stress test, and haven’t experienced chest pain or other overt symptoms, you can likely wait two years before repeating the stress test. If you do have coronary artery disease and are at high risk but aren’t having symptoms, the same guideline applies."
Normally most of the research studies have been done predominantly with males in mind and they only began including women recently. You also have protective hormones and ameliorate risk somewhat. That advantage is lost with menopause.
You need to talk to your cardiologist for personalized guidance. I would be interested in advanced lipid screens.
I'd find a different doctor...If you already had a positive stress test, does he expect a repeat test to tell him something new?...Can you trust a negtve test at this point?...If it's positve again, will you be submitted to a cath again every six months? An illogical plan.
While the radiation dose of a nuclear scan is small, doing two every year, starting in a 30-something pt, may add up before you know it.
The Viet Nam experience gave us the chance to look inside the chests of 19 yr-olds in large numbers, and found that hardening of the coronary arteries does in fact start to show up that early. The real question is how fast does it progress over time?
You seem to have low risk for CAD based on BP, chol, BS levels & no smoking. You don't really have a strong family hx of CAD (only one of your relatives seemed to be affected at an early age). ...But statistics only apply to the group, not the individual, despite the routine use of "cardiac risk scores."
We could recommend a cardiac CT scan to get a baseline value and then repeat it in a year or three to follow the prgression of your occulsion. The scan isn't all that accurate becaue it depends on the inclusion of calcium into damaged artery, which takes time, not on the acutal amount of damage.
The ony real way to follow your course is to repeat the cath at some time in the future-- far enough off that it gives enough time for changes to show up, but not so far in the future that we miss a chance for timely intervention.
In terms of intervention now-- for every study that says ASA helps, we can find one that says it doesn't. There's no solid evidence that statins help taken prophyllactively. It's good advice for anyone to eat moderately and avoid excessive weight gain, and exercise has been shown to help as much in preventing CAD as lowering the chol.
It's not time to panic.
edit-- I just re-read your post-- do you mean 2x / yr or every other year? Either way, once you've had a positive stress test, that test becomes useless for diagnostic purposes-- you can no longer trust a negative result, and a postive doesn't tell you how much occlusion you have. You must resort to a repeat cath to know for sure.
Last edited by guidoLaMoto; 07-17-2021 at 03:28 AM..
I'd find a different doctor...If you already had a positive stress test, does he expect a repeat test to tell him something new?...Can you trust a negtve test at this point?...If it's positve again, will you be submitted to a cath again every six months? An illogical plan.
While the radiation dose of a nuclear scan is small, doing two every year, starting in a 30-something pt, may add up before you know it.
The Viet Nam experience gave us the chance to look inside the chests of 19 yr-olds in large numbers, and found that hardening of the coronary arteries does in fact start to show up that early. The real question is how fast does it progress over time?
You seem to have low risk for CAD based on BP, chol, BS levels & no smoking. You don't really have a strong family hx of CAD (only one of your relatives seemed to be affected at an early age). ...But statistics only apply to the group, not the individual, despite the routine use of "cardiac risk scores."
We could recommend a cardiac CT scan to get a baseline value and then repeat it in a year or three to follow the prgression of your occulsion. The scan isn't all that accurate becaue it depends on the inclusion of calcium into damaged artery, which takes time, not on the acutal amount of damage.
The ony real way to follow your course is to repeat the cath at some time in the future-- far enough off that it gives enough time for changes to show up, but not so far in the future that we miss a chance for timely intervention.
In terms of intervention now-- for every study that says ASA helps, we can find one that says it doesn't. There's no solid evidence that statins help taken prophyllactively. It's good advice for anyone to eat moderately and avoid excessive weight gain, and exercise has been shown to help as much in preventing CAD as lowering the chol.
It's not time to panic.
edit-- I just re-read your post-- do you mean 2x / yr or every other year? Either way, once you've had a positive stress test, that test becomes useless for diagnostic purposes-- you can no longer trust a negative result, and a postive doesn't tell you how much occlusion you have. You must resort to a repeat cath to know for sure.
Thank you for the reply and all the great info! I also was concerned about how accurate another stress test will be with already having a false positive. It was every two years for the nuclear stress. Would any cardiologist perform a heart Cath for prevention? Or is this likely not an option.. not that I want to have one done again! It doesn't seem like there are many other preventative options that give clear answers.
I am late replying as we have had some unfortunate things happen lately which ultimately I wonder if will have effects to the heart. We had a couple early miscarriages which lead to testing and have found that I have MTHFR and Factor V Leiden. I'm to have homocysteine levels checked next week(along with other things) but my cardiologist mentioned checking homocysteine levels months ago but never did. This can be linked to cardiovascular events.. if I remember right? Curious if you know about homocysteine levels and effects on the heart?
I'm to have homocysteine levels checked next week(along with other things) but my cardiologist mentioned checking homocysteine levels months ago but never did. This can be linked to cardiovascular events.. if I remember right? Curious if you know about homocysteine levels and effects on the heart?
Genetic hyperhomocysteinemic states can be associated with heart disease as mentioned along with other disorders such as Lp(a).
Homocysteine levels are elevated in B12 deficiency states as is a good if not better marker for B12 deficiency. Unfortunately MTHFR is genetically inherited disorder that can result in elevated homocysteine levels. It's also unfortunate that clinical trials using B12 and Folate and or B6 did not produce reductions in risk of CAD or thrombosis.
Some people with MTHFR gene mutations have normal homocysteine levels and don't cause much of a problem. We don't know how much of a problem it is until it is measured.
I would suggest that you fast for the homocysteine level as it can be impacted by recent food.
You also have a thrombophilic state (prothrombotic) with Factor V Leiden. It is predominantly venous thrombosis rather than arterial. It has also been associated with miscarriages.
I would suggest you listen to the healthcare providers with your care and if you feel something isn't right than see another doctor for a face to face second opinion.
Last edited by Medical Lab Guy; 09-03-2021 at 04:40 PM..
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