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Cardiac Rehabilitation

Understanding and Responding to Test Results

05/07/2007

Question:

Recent stress test results--modearte lad blockage-- Rest lvef-66%,post stress lvef-74%. Last year stess-normal with same lvef & post stress no`s. cardiologist recommends catherization. 2nd opinion--no cath, not severe enough--get a ct angiogram on 64 slicer for further clarification as 1st study showing artifact-results maybe a false positive. Insurance won`t cover other test. Told rubidium pet covered. Is it just as good? Don`t want cath with stenting if I don`t need it, esp if 2nd doc says not needed. 2nd question-- what is the consensus in medical community with people with moderate lad blockage, asymptomatic-no chest pains, or shortness of breath. Does the rubidium pet of heart provide a read that is just as effective as the angiogram on 64 ct slicer that I am having trouble getting insurance approval for. If not, is it worth paying out of pocket for best results possible to avoid invasive diagnostic procedure to get to the bottom of this problem? I need cardiological clearance for another procidure--bronchoscopy for lung abnormality.Concerned if I get it with 2nd opinion doctor and don`t get catherization, maybe at greater risk for heart attack? Please render your opinions. Maybe get a 3rd cardio opinion.

Answer:

If your recent stress test was read as abnormal, the usual next step is to perform a cardiac catheterization to evaluate for a blockage in the coronary arteries. A coronary CT is usually only performed if the stress test is equivocal. The CT and PET scans are not as good as cath for determining the actual severity of a coronary stenosis.

If you need pre-op clearance, I suggest discussing your options with your Cardiologist.

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Response by:

Karen   Kutoloski, DO Karen Kutoloski, DO
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University