Catheter Angiogram for Chest Pain but Low Heart Disease Risk?

Low risk for heart disease but chest pain? Which test is warranted: CT angiogram or catheter angiogram?
Find out what someone with low risk for heart disease should do if they have suspicious symptoms and want more than a stress test: cath angiogram or CAT scan?
Suppose you’re at low risk for heart disease (clogged arteries) in that you exercise, don’t smoke, aren’t overweight, have normal blood pressure, are not diabetic and eat mindfully, but…you’ve been having chest pains, especially upon exertion (or new-onset shortness of breath that’s out of proportion to level of activity).
Should you go straight to the cath lab? Or first undergo the non-invasive CT angiogram?
“You need to understand CT angio vs. cardiac cath angio before you throw up your hands in despair,” says Monica Reynolds, MD, a cardiologist with ColumbiaDoctors Medical Group in White Plains, NY.
“In summary – CT angio is really not much safer than a traditional cardiac cath.”
The CT angiogram involves significant radiation exposure, but the cath angiogram requires threading a catheter through the coronary arteries.
“And if significant disease is found, only the traditional cardiac cath allows the operator to proceed directly to stenting,” says Dr. Reynolds.
Placing a stent can be done while the catheter is already in place, if it’s determined that’s all the patient needs (i.e., bypass surgery not needed).
“CT angio for coronary arteries was the hot topic a few years ago, but has since fallen out of favor for several reasons,” continues Dr. Reynolds.
First of all, if one’s coronary calcium score is high enough, the calcified deposits will make it difficult to interpret the image from a CT angiogram.
“Patients with CAD almost always have significant calcium deposits. So CTA is really only useful in patients WITHOUT coronary disease, i.e., in healthy patients to rule out CAD.
“Here’s the downside of the CTA – CTA still requires injection of contrast dye and involves radiation,” says Dr. Reynolds.
“Therefore, the risk of an allergic reaction to the dye or risk to the kidneys from the dye in renal patients is the same whether you get a CTA or cath.
“The only advantage over a regular cardiac cath is that the test is performed using a peripheral IV rather than a central stick (usually into the femoral artery).”
Renal pertains to kidneys. The femoral artery is the main thigh artery.
“As I noted above, the other downside to CTA is that if disease is found, you can’t do anything about it. If a stent is needed, the patient then needs to have a cardiac cath to place the stent.”
When my mother was admitted to the hospital (from the ER) with chest pain, the cardiologist ordered a catheter angiogram; he bypassed the CT angiogram. Why?
Because my mother was at very high risk for severe heart disease or cardiac problems based on several factors: 1) Slightly elevated troponin level during ER visit, 2) Elderly age, 3) Abnormal echocardiogram, 4) High triglycerides.
Why waste time on a CTA with this type of patient?
It would only delay what the cardiologist probably was already anticipating: a need for a stent or even bypass surgery, plus expose her to unnecessary radiation and possible insult to kidneys from the contrast dye.
The catheter angiogram revealed “significant blockage” and about two hours later, she was undergoing quintuple bypass surgery!
“So here we go again – PRETEST PROBABLILITY OF DISEASE – if the doctor thinks a patient has normal coronaries but the patient has ongoing symptoms or is worried about coronary disease (CAD), a CTA can be done to rule out CAD,” explains Dr. Reynolds.
“This is being done more and more in the ER setting to expedite the evaluation process.” See link above in yellow highlight.
“However, if a patient is likely to have coronary disease (or the patient had a high CT calcium score), a cardiac cath is a better, more useful, more direct, and really safer approach to diagnosing and treating the disease.
“Current complication rates for cardiac cath, stent, etc., in a generally healthy patient are extremely low!
“Most complications occur in patients with unstable coronary disease and multiple medical comorbidities.”
Since 1992 Dr. Reynolds has practiced clinical cardiology at ColumbiaDoctors Medical Group, one of the largest multi-specialty practices in New York State.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Shutterstock/Pitchayaarch Photography
Normal Stress Test but a Massive Heart Attack the Next Day ?

A cardiologist explains why you can have a normal stress test one day and then a massive heart attack the next.
You’ve probably heard of instances in which a person had a normal stress test but then next day dropped dead of a massive heart attack. How can this be?
“We have more and more theories about how plaque develops within the coronary arteries,” says Monica Reynolds, MD, a cardiologist with ColumbiaDoctors Medical Group in White Plains, NY.
“We are starting to understand how soft plaque can rupture and lead to greater plaque formation.
“Sometimes these ruptures are minor and result in minor or no symptoms, but other times the rupture can be catastrophic, resulting in a totally occluded artery where before there had only been minor non-obstructive plaque.
“This catastrophic rupture often explains how a patient can have a normal stress test one day and a massive heart attack the next.”
To make this easier to understand, imagine a tube. The inner wall of the tube is only lightly covered with patches of sludge.
Water flows freely through the tube; there is no narrowing or restriction of the water flow.
One day, a piece of the sludge dislodges from the inner wall and travels down the tube, getting stuck at some point—stuck in a way that it blocks the flow of water.
That’s how a heart attack occurs when soft plaque ruptures in a coronary artery that, according to a stress test, has no restricted blood flow.
What a Stress Test Looks For
A stress test measures perfusion: blood flow through the coronary arteries.
A stress test does not measure amount of soft plaque, and it’s the soft plaque that can rupture (hard or calcified plaque can’t).
To kick back any soft plaque you may have in your coronary arteries, avoid processed food as much as possible.
So if you want a chicken, rice and broccoli dinner, make it the way someone in the year 1902 would have made it, rather than buying a frozen dinner.
Though it’s nice to know that one’s stress test was normal, there’s always that small chance that a massive heart attack is around the corner.
This is why it’s so important to keep on top of your heart health even if you don’t seem to have any risk factors or suspicious symptoms.
Since 1992 Dr. Reynolds has practiced clinical cardiology at ColumbiaDoctors Medical Group, one of the largest multi-specialty practices in New York State.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Shutterstock
Is Exercise Safe if You Have PVCs 24/7?

A cardiologist addresses exercise safety in people with many PVCs, even nonstop.
Some people have premature ventricular contractions seemingly nonstop, thousands and thousands a day, and fear that exercise may not be safe for them.
“PVC’s had a bad reputation many years ago,” begins Monica Reynolds, MD, a cardiologist with ColumbiaDoctors Medical Group in White Plains, NY.
“When I was first in training, we were very aggressive in treating PVCs, especially in patients who had CAD, because the theory was that patients with PVCs were at high risk for cardiac arrest (V-fib or V-tach).”
CAD stands for coronary artery disease.
Dr. Reynolds continues, “In fact, we tried suppressing them with two infamous medications – Encainide and Fleciainide. Unfortunately, more patients died from the medications than from the PVCs.
“Since then, we’ve done a lot more research on PVCs and ventricular arrhythmias and risk of sudden cardiac death.
“We now use beta blockers, amiodarone, and ICDs (implantable defibrillators) in patients at high-risk for sudden death (low EF, prior cardiac arrest, etc.).”
EF stands for ejection fraction, the amount of blood that the heart beats with each pump. A low EF corresponds to weak pumping ability.
Exercise with PVCs Is Safe for Healthy Individuals
“PVCs in a healthy patient are rarely anything to worry about,” says Dr. Reynolds.
“We usually will do a holter, echo, and stress test to screen for more ominous arrhythmias.

Freepik.com
“Family history is also important to document, i.e., any family history of sudden death?
“Assuming everything checks out fine, then yes, you can exercise to your heart’s content (pun intended). Exercise actually suppresses benign PVCs.”
Exercise is safe for those with premature ventricular contractions who are healthy. This includes strength training.
Don’t let PVCs stop you from exercise if your cardiologist has given you the green light.
Since 1992 Dr. Reynolds has practiced clinical cardiology at ColumbiaDoctors Medical Group, one of the largest multi-specialty practices in New York State.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
How Does Exercise Suppress PVCs?

A cardiologist explains how exercise suppresses or inhibits PVCs: premature ventricular contractions.
Though some people with PVCs wonder if it’s safe to exercise, it’s a well-documented fact that exercise suppresses PVCs.
In fact, many individuals who have frequent premature ventricular contractions report that exercise is a reliable, predictable way to stop them cold.
How does exercise stop or suppress premature ventricular contractions?
“Premature beats originate during the ‘resting’ phase of the cardiac cycle, i.e., the time when the myocardial electrical activity has reset itself and is waiting for the next electrical wave coming down from the atria -> through the AV node -> through the His bundles -> and then through the ventricular myocardium,” explains Monica Reynolds, MD, a cardiologist with ColumbiaDoctors Medical Group in White Plains, NY.
“With exercise, the heart rate increases which essentially shortens the ‘resting’ time and reduces the amount of time that PVCs can originate.
“Basically, the increased electrical activity of the faster beating heart overrides the aberrant beats in the ventricles.”
So even though you may have heard that the reason exercise seems to make PVCs go away is because PVCs can’t be felt as much when your heart rate is elevated and you’re huffing and puffing during physical activity, it’s a fact that working out actually inhibits PVCs.
And this process has nothing to do with the individual’s perception.




















