this is almost a simi complaint to my uncle in a way, and a question to you who may know more, as im not a doc, first off my uncle is now like 60 on a ton of meds and his blood is fine, he had 2 hard attacks a couple years appart first at like 30, my complaint on him his that he literally sits on his ass all day as he did 95 % of his life,doesnt work, eats ruffly prob close to a gallon of ice cream in a week, all the hyrogenated butter and peanut butter shit foods thats just to start, he borrows money from my his mother for meds and stress test ect. so he can stay alive, but the way he lives its like whats the point u know, hes literaly a vegtable and a waist of breath, the stress test cost alot i here, and puts a burden on the family, if his blood cholesterol and pressure are fine, has not had heart probs since 30's does he need these test as long as his blood is in check, it seems like unesscary spending
Stress testing has a lot of value, specifically the myocardial perfusion imagery variety. Increasing the workload on the heart can bring many things to the surface, such as arrhythmias, conduction issues, and evidence of ischemic territory/ies. Not to mention, there's a lot of predictive value in knowing an individuals exercise tolerance and capacity, as well as the ability (or lack there of) of their HR to return to resting range (60-100) in recovery.
Cardiac catherization is considered the gold standard for determining exact % occlusion within the coronaries. However, what the catherization fails to do is determine the level of ischemia in the patient. Ischemia is the depravation of blood flow to the myocardium that brings on angina. This is where the stress test with imaging comes in.
By increasing the workload on the heart, if there is blockage present in the coronaries not allowing adequate blood supply to reach the myocardium, changes in the ST segments of the ECG will appear, followed shortly by symptoms, including pain, pressure, discomfort in the chest, neck, left shoulder/upper arm, between the scapula and/or excessive shortness of breath. By this occurring, the testers have been able to determine at what % of the age predicted HR max that the patient's heart begins to have difficulty keeping up with the myocardium's demand for oxygenated blood. When this is combined with the imaging, physicians are able to determine just how severe the ischemia is, and indicate which coronaries are most likely the culprit. A stress test with imaging is over 90% sensitive at detecting CAD. A non-imaging stress test is 70% at best at detecting CAD.
Your uncle has known disease. Your uncle also has myocardial scaring as result of the MIs he's had, meaning there's dead cardiac tissue, which means less of his heart is able to contract to circulate blood through out the system. He has lower then normal ejection fraction. During the performing of the stress images following the treadmill or pharmacologic test, the technologist would gate the patient which would determine a current ejection fraction. This would be particularly valuable if the patient hasn't had an echocardiogram in quite some time, which would have provided an EF as well.
Based on the facts you've provided on your uncle, it's safe to say his disease has probably progressed and he wouldn't receive good news as a result of the test. He'd potentially be admitted into the hospital as a result. This is the reality of what faces him. Even though you know some of this, and now know a lot more after reading, your uncle's life is in his own hands and it's his decision to make, as to whether his life is valuable enough or not to do something about his situation. Some people hear bad news once and it's enough of a wake up call to change them forever. Other people may require a few slaps of reality before they realize how things really are. Perhaps this next go around with testing would be enough to open your uncles eyes and get him to lead a healthier lifestyle.
There are many patients I deal with on a weekly basis that come in for testing who truly have no business being there. They had atypical symptoms, perhaps 1 risk factor for heart disease, and otherwise healthy. The stress test w/ imaging is over $6,000, at least at the large scale academic hospital that I work for. This is money wasted for the patients I just described. That money would be better spent on a piece of cardio equipment for their house! This isn't the case for your uncle. For your uncle, thats exactly what he should be spending his money on. He needs it, and perhaps a lot more than that.
Please advise your uncle to do the right thing.
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