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Dr. Andrew Rynne

Family Physician

Exp 50 years

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How does this make sense. How to understand the difference in diagnosis ?

1 doctor says-there is excessive bloodflow to the anterseptal and apex of the wall of the heart and is corrected in resting images and would like to do a angio. sometime later a second doctor see the same thing and but it shows up in the resting images too but does not feel the need to do angio..How does this make sence ? i had a heart attack and that was the injury
Tue, 15 Dec 2009
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The information you are giving makes it difficult to answer your questions, because we are missing alot. I will start by agreeing that you need more information and from a professional that has the actual test in front of them. Remember that the doctors work for "you". You hired them to take care of you and that includes helping you understand what they are doing. However, I will make a couple off assumptions. Based on the terms "corrected in resting images" , I assume you had a nuclear medicine stress test. This is where they look at how your heart "feeds itself" (how the blood vessels work) during physical "stress" and generally they compare that information to the heart at "rest". The term "excessive" blood flow is confusing as we are most concerned about "restrictive" blood flow that would indicated parts of your heart weren't getting enough blood flow. But there must be some parts of the report missing. Regardless, the scans are "read" by radiologists, cardiologists, or other physicians trained in nuclear medicine. The doctor that gives you the report is rarely the same one that read the test. So, too, often, the study is read twice. The first time through, the physician is unaware of the clinical data (except for patient sex), in order not to bias the reading. After this thorough interpretation, the study is briefly reviewed again, and additional available information is considered, such as the patient’s history, the results of the stress test, and the results of other diagnostic tests. This second interpretation may clarify the perfusion pattern that is more clinically relevant. Lastly, there are two possible "angios" that the doctor could have been recommending. A CT "angio" is a minimally invasive (requires an I.V. site) CT Scan of the heart. A Cardiac angio, also called cardiac catheterization is more involved and is a outpatient procedure done in the cath lab. That usually involves referral to a cardiologist. The second doctor you mentioned may have been a cardiologist, you didn't mention who the 2 doctors were. In any event, it is important that you ask the doctor to explain the results to you and explain (in terms you understand) why you do or do not need further evaluation. It is their RESPONSIBILITY. As always, if you don't understand or agree with this explanation, seek a second opinion, but make sure to get the report of your scan or have those records made available to the other physician.
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