Expert Advise Needed Quickly Regarding Cardiac Catherization

  1. Hello,
    I need some real quick advise about cardiac caths. Hopefully, someone will respond at this late date.
    Last Thursday night while driving, I experienced some chest pain radiating to my right shoulder and back, shortness of breath and severe diaphoresis. I presented to the ER where I was admitted to the telemetry unit overnight. All EKG's were normal. I never experienced any more chest pain that night....this episode lasted approximately 45 minutes. As far as I have been informed, my telemetry readings were normal all night. Early the next morning I was given a cardiac treadmill stress test. This apparently came out good too. The cardiologist that was with me told me that the echo was normal, my valves all looked good and the EKG just before the stress test was normal. Then he said the EKG during and after the test did not come back normal. He said if I have any more chest pain, they would automatically do a catheterization.
    Well, I have had 2 more separate episodes of very mild pain in my chest and my right arm. I didn't call him as I was instructed. I have a appointment with him first thing in the morning for a follow up exam.
    Heres my question....do you think this warrants a cardiac catheterization this quickly? I have experienced a heck of a lot of stress in the past few months and I am hoping that it is stress related and can be treated by rest (medical leave from work for a few weeks) and medicine...antidepressant and whatever he suggests.
    How should I express my concerns to this doctor without insulting his professional opinion? What questions should I have ready? CAn anyone give me a brief overview of the procedure? I have NO cardiac nursing experience and this is putting even more stress on me.
    Thanks for your insights
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  2. 14 Comments

  3. by   Dinith88
    By telling you that your stress-test was abnormal, the doctor saw some ischemic-type changes associated with exercise. This warrants investigation via catheterization. What sounds odd is that you had an abnormal stress and the doctor sent you away without having an angio!!??!!! That's scarey.

    Now, had your stress-test been 'normal' and you still had these symptoms it might be
    appropriate to 'wait until it happens again'...just to rule out coronary disease.

    Put it this way: Abnormal stress-test IS A STRONG INDICATOR of heart disease...and is usually the fast-track to an angio.

    Now, if your doctor saw an abnormal stress-test, sent you home and decided to 'wait till it happens again'....this could be considered malpractice. You may be an MI waiting to happen. The 'next time' could be the last time...if you catch my drift.

    If it were me, i'd call his arse right now, and ask him to clarify the 'abnormal' stress-test. If it was truly and abnormal stress then yes you need to have an angiogram...and get a new freakin cardiologist!
  4. by   zambezi
    I agree with Dinith...especially since you continue to have minor episodes of pain after the abnormal stress test...If your pain is related to an occlusion in one of your coronary arteries, the best way to preserve heart muscle and function is to have the occlusion fixed though PTCA/stenting etc. If you wait and the vessel closes off and you have a heart attack...well there goes the muscle, time is of the essence in this situation...I think that it would be in your best interest to go though with the procedure...if is does come up negative, at the very least it will give your peace of mind...
  5. by   nurturing_angel
    Thanks for the information. I do appreciate it and I will go to my appointment in the morning with a little more confidence....know what to expect and what to ask for. I will probably be having a cath done asap.


  6. by   moonchild20002000
    I agree with the advice from the other posters.
    You really need to know what is going on.
    I had a cath a couple of years ago,if you need any more info just pm me.
  7. by   nurturing_angel
    I have a appointment for a cardiac cath for next week..barring emergencies.
    I am terrified but agree that I need to know what is going on. My family has a strong history of diabetes and heart problems.


    Thanks for the advice. You helped me more than words can say.
  8. by   zambezi
    Good luck with the cath...I hope that they find that everything is okay...but like I said before, if you do have occlusions, it is better to fix them now before it is an emergency! Feel free to post any questions you may have about the procedure...there are a lot of people here that work both in the cath lab and post procedural areas...
  9. by   MarkHammerschmidt
    Given the family history of diabetes and all, even without any documented renal problems, you might want to ask about pre- and post-cath doses of mucomyst /acetylcysteine, which does a nice job of preventing some/most of the damage inflicted on the beans by the iodine-based dye. I'm a type 2 guy with no discernable renal problems at all, but I would absolutely request it, even though it tastes godawful nasty. Maybe mix with cranberry juice, ice, etc.? Best of luck.
  10. by   CCU NRS
    Here is a site with very basic info and a picture. this shows a brachial cath site, most of the ones we do are groin/femoral, you get the gist though.

    http://health.allrefer.com/health/ar...teriogram.html

    Couple of other things, you can discuss, how do they proceed? either femoral or brachial? Does he use angioseal or vaso-seal any closure device? Do they have closur-pad? The difference can mean a long time flat on your back.(the closure devices are medical intervention at the site, closur pad is a pad that promotes clotting that a nurse can apply at the time of pulling the sheath) I would ask exactly what were the findings of the stress test that indicated his concerns? If he is any good he will explain the entire process, even if you can not understand him very well (no offense intended) just make him repeat anything you don't understand, most of the cardiologists I know will draw a picture if you want to see where it is. Just choose wisely and remember you can get a second opinion.
  11. by   StephanieMc
    Quote from Dinith88
    By telling you that your stress-test was abnormal, the doctor saw some ischemic-type changes associated with exercise. This warrants investigation via catheterization. What sounds odd is that you had an abnormal stress and the doctor sent you away without having an angio!!??!!! That's scarey.

    Now, had your stress-test been 'normal' and you still had these symptoms it might be
    appropriate to 'wait until it happens again'...just to rule out coronary disease.

    Put it this way: Abnormal stress-test IS A STRONG INDICATOR of heart disease...and is usually the fast-track to an angio.

    Now, if your doctor saw an abnormal stress-test, sent you home and decided to 'wait till it happens again'....this could be considered malpractice. You may be an MI waiting to happen. The 'next time' could be the last time...if you catch my drift.

    If it were me, i'd call his arse right now, and ask him to clarify the 'abnormal' stress-test. If it was truly and abnormal stress then yes you need to have an angiogram...and get a new freakin cardiologist!
    I totally agree with your answer to her question. Quit trying to blame this on other reasons when the stress test came back abnormal. Denial is a straight road to an MI and you may not get a second chance. Fire that cardio and get another but have that angiogram quickly!!
  12. by   nurturing_angel
    Hi,
    My appointment for my cath is coming up very soon and I just found out that my hemoglobin last friday was 10.1....since then I have had 3 days of very heavy menstrual bleeding (a whole separate problem I am dealing with now)and I am wondering how worried I should be about this. Any advice would be appreciated.

    Thanks so very much!
  13. by   rjflyn
    YES you should have a cath done as soon as possible. I also would suggest that if you are working stop until having done so. Your other issue now could be because of the added stress you are undergoing. The low Hbg compounds things as this can put extra stress on you heart as well. I would recommend you talk with you primary care provider or who ever is taking call for that doctor as soon as possible for guidance (now).
    Rj


    Quote from nurturing_angel
    Hello,
    I need some real quick advise about cardiac caths. Hopefully, someone will respond at this late date.
    Last Thursday night while driving, I experienced some chest pain radiating to my right shoulder and back, shortness of breath and severe diaphoresis. I presented to the ER where I was admitted to the telemetry unit overnight. All EKG's were normal. I never experienced any more chest pain that night....this episode lasted approximately 45 minutes. As far as I have been informed, my telemetry readings were normal all night. Early the next morning I was given a cardiac treadmill stress test. This apparently came out good too. The cardiologist that was with me told me that the echo was normal, my valves all looked good and the EKG just before the stress test was normal. Then he said the EKG during and after the test did not come back normal. He said if I have any more chest pain, they would automatically do a catheterization.
    Well, I have had 2 more separate episodes of very mild pain in my chest and my right arm. I didn't call him as I was instructed. I have a appointment with him first thing in the morning for a follow up exam.
    Heres my question....do you think this warrants a cardiac catheterization this quickly? I have experienced a heck of a lot of stress in the past few months and I am hoping that it is stress related and can be treated by rest (medical leave from work for a few weeks) and medicine...antidepressant and whatever he suggests.
    How should I express my concerns to this doctor without insulting his professional opinion? What questions should I have ready? CAn anyone give me a brief overview of the procedure? I have NO cardiac nursing experience and this is putting even more stress on me.
    Thanks for your insights
    Last edit by rjflyn on May 25, '04
  14. by   nurturing_angel
    Heres another update.
    I had my cardiac cath yesterday and they found 2 occlusions of my caronary arteries. One was very small and was easily eliminated with a balloon angioplasty. The other one, which supplied blood to the anterior portions of my heart was 80 % occluded and I had a stent placed.
    I am glad that I had it done now. Thanks to all of you for your advise.
    I am very tired today.....my hgb was only 8.8 this morning. But I am sure that things will start looking better now.

    Thanks again!

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