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Heart problem,suffocated,chest-pain,weakness,ECG,blood test x-ray,treadmill and echocardiography tests normal.CT scan coronary test required?

39 old, male, non-smoker 8 months ago heart problems started. Symptoms are constant sufocation on rest and on moving, sometimes chest-pain, weakness. In December 2011 went to Emergency , the following tests were ECG , blood tests ans x-rays normal. After that recomended by my cardilogists I had Two treadmill test negative, echocardiography is ok. Symptoms are persistent two months after the latest tests and my cardiologist recomend CTscan Coronography. My question is do this CT Scan is neded because all results are negative?
Asked On : Tue, 17 Apr 2012
Answers:  2 Views:  85
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Cardiologist 's  Response
hello and welcome. well CT angiography is a non invasive modality to assess the heart arteries( coronaries). it has around 8 indications in which indication for the chest pain patients are those patients in whom the probabilty of having the heart arteries narrowing causing symptoms in intermediate ( eg with risk factors , on going chest pain with other tests equivocal/ not conclusive , or the coronary artery anomalies associated with chest pain....)
as you have NO risk factors and probability for the likelihood of coronary artery disease in less ....because your other tests including the TREADMILL /ETT negative with cardiac markers also negative.... THERE IS A CHANCE OF FALSE POSITIVE MORE , AND FURTHER UNNECESSARY INVASIVE PROCEDURES TO CONCLUDE ITS FALSE POSITIVE FINDINGS WOULD STILL BE MANDATORY THEN. CT ANGIOGRAPHY ITSELF IS NOT HAZARD FREE , RADIATIONS , IONIZING DYES ARE USED..
according to the AMERICAN COLLEGE OF CARDIOLOGY /ACC the low probability patients should go for ETT ( which yours is negative twice) ...intermediate probability should go for CT angio and high probability for direct INVASIVE angiography....
i would suggest that its more logical to go through a DOBUTAMINE STRESS TEST , equivalent to TREADMILL TEST but one plus point is that it would help seeing the motions of the heart being slowed /abnormal in case there is a disease ..... non invasive , hazard free....AND NOT EXPENSIVE LIKE CT ANGIOGRAPHY....
also your pain pattern at rest and exertion makes your disease pattern more severe in which case other tests should have been positive...which are actually not .. i think you should discuss again with a senior cardiologist about your query .THANKS
Answered: Wed, 9 May 2012
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General & Family Physician Dr. Pavan Kumar Gupta's  Response
Since your symptoms are persistent and suggestive of cardiac involvement and all non invasive tests like treadmill and echocardiography are normal,a direct visualization of your coronary artery becomes must and this can be done by a CT coronary angiogram.
You must get this investigation done.
Answered: Tue, 17 Apr 2012
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