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Dr. Andrew Rynne

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What does my stress test report indicate?

Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6550 Questions

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Posted on Fri, 8 Dec 2017 in General Health
Question: My pulmonologist said tests he did indicated need for echo stress test to rule out ischemic heart disease and referred me to a cardiology practice who scheduled the test. They even got approval from ins. co. I'm having symptoms and anxious (but eager) for the test. The test was to be tomorrow. Somehow -- not clear -- my PCP inserted herself (otherwise not involved) and I got a XXXXXXX call from the cardiology office (now with an attitude) saying they cancelled my echo due to the PCP and won't perform it (maybe not at all) until I come in for a consult. What happened -- why now only the consult? PCP apologized for the 'mix up' saying if this cardiology office won't do the echo, she'll try to find me someone. But I was referred to top notch doctors -- and if they for some reason decide not to re-schedule (decline) the test, my insurance coverage (and health) are at risk. Why all of a sudden only the consult? ( The pulmonologist was not in office Fridaybwhen this unfolded.)
doctor
Answered by Dr. Ilir Sharka 52 minutes later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I passed carefully through your question and would explain that it is important to investigate for any any possible serious pulmonary disorder, before performing a cardiac ultrasound. This is because the cardiac image on the echo is closely related to the lungs clinical situation.

That is why, it is necessary performing a pulmonologist consult first, before the cardiac echo.

Besides, you should know that besides echo stress test, two other tests are helpful to investigate for coronary artery disease: coronary angio CT scan and nuclear perfusional cardiac stress test.

As a cardiologist I would recommend performing on of these two tests, instead of stress echo in your clinical situation.

These two tests do not interfere with any lung disorders.

You should discuss with your attending physicion on the above test options.

Hope you will find this answer helpful!

If you have any other questions, please feel free to ask me again!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 19 minutes later
Respectfully, I can't control what tests the pulmonologist orders -- but I appreciate your info and will do further reading.

My question is rather how to 'save' the only text ordered-- as that is the only path I have -- and specifically ( please see original question) why would the cardiologist cancel the already scheduled echo ordered by pulmonologist based on contact by uninvolved PCP and now will do only consult?

Thank you.
Note: The PCP apologized for the ' mix up' but that doesn't help my health. She was not involved at all. Her interference stopped a scheduled test ordered by the respected pulmonologist.

Why would the cardiology office do that -- disrespecting a specialist/my treating physician over a PCP (whose name I didn't even put on the patient paperwork I filled out for the cardiologist).

Thanks.
doctor
Answered by Dr. Ilir Sharka 11 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I understand your concern and I am not really sure, what may have happened between our PCP and the cardiologist.

Anyway, as I explained to you, it is necessary to have a careful lung examination from the pneumologist, in order to perform a cardiac stress echo.

Many lung disorders, can interfere with this test, as the cardiac ultrasound is performed through the chest wall (and the lungs which underneath it).

So, in case of a lung disorder, which imposes a weak view in the cardiac ultrasound, the cardiac stress echo would not be the best test to investigate for cardiac ischemia (or coronary artery disease), as the results could be non-reliable.

It is usually a cardiologist decision to choose which is the best test to perform at a specific patient, based on his clinical situation and other comorbidities.

Anyway, I recommend discussing with your PCP or cardiologist on the possibility of the other above mentioned tests (coronary angio CT scan or nuclear perfusional cardiac stress test), to investigate for coronary artery disease, as these tests do not interfere with the lungs situations.

Hope to have clarified some of your uncertainties!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 44 minutes later
Thank you. I really appreciate your explanations.

In my prior question I did not include the following information in order to be brief and because I was more concerned about the stress echo being canceled.

Be highly regarded pulmonologist-my doctor for about 10 years due to adult onset asthma- recently did breathing test plus a regular stress test. As I understand it the result stress showed restrictive component as well as cardiac component to my DYSPNEA. I had had recent pretty severe chest pains. Wants to rule out ischemic heart disease.

Does the above additional information seem to make more sense as to why the stress echo was ordered ?

Thank you.

Postscript: The PCP is newer to me and was totally uninvolved with the above tests. I'm not sure why/how she got involved and had the stress echo canceled
doctor
Answered by Dr. Ilir Sharka 4 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Thank you for the additional information!

Asthma can lead to chronic pulmonary changes, which can cause the above mentioned visive problems, while performing the cardiac stress echo.

That is why, I would recommend performing a coronary angio CT scan or nuclear perfusional cardiac stress test, rather than stress echo, in your clinical situation. These tests are very reliable for the investigation for coronary artery disease.

I am not sure, if this is also your PCP opinion.

But, I can really not judge her behavior. You should ask her directly about it, for a more clear explanation, if you have doubts on that.

Hope to have been helpful!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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