Cardiology tests?

[Hematocrit13]

Hello everyone,

I work in a clinic and occasionally, not often, it happens that one or two patients want to meet with me privately. I recently met with a 50 year old female patient who says she occasionally has SOB, some palpitations (PVCs, according to a recent progress note) and transient chest pain, including a burning pain. She inquired about which tests she should get to rule out heart disease. Naturally, I advised her to talk to her provider, she said she does and will, but she just wanted to see what I thought in the meantime. Her blood pressure is fine, she does have severe sleep apnea, which is treated with CPAP. There is a strong family history of heart disease, but no diabetes or kidney disease, and her labs are all apparently fine. She says in the past her doctor ordered echocardiograms which she’s had two of over the last 4 years. They show some mild regurg in one or two valves (she can’t remember), and everything else with the echos are normal, but she worries nonetheless, concerned about the occasional pain below the left breast. Would either a stress test or halter monitor be something I could suggest she talk to her PCP about? She was asking how she can tell if there’s any blockage, inflammation or anything else wrong with her coronary arteries and if she should get anything like a CT. She seems to know that there are several tests to ask about because she also asked about the coronary calcium scan, but I felt bad because at the time I couldn't tell her much about it, or many other tests, frankly! I will strongly recommend she talk to her doctor, obviously, since I am far from an expert, but I thought I’d tap the resources here to see if anyone has any suggestions about how to shape this conversation, so I can maybe be a bit more prepared when she returns next week. Also, I myself will let the doctor know that she dropped by, and what her suggestions would be for this patient.

[nursej22, MSN, RN]

Yes, she needs to talk to the doctor. There are many different tests that are ordered on the basis of the patient's report and assessment. I would tread lightly on recommending a specific one. And doctors have their own preferences based on their experience and knowledge. If the doctor is not a cardiologist, then perhaps you could suggest a consult.

Good for you for being this patient's advocate.

[Thuber]

Hi there- Yes this lady definitely needs to follow up with her family physician about the most appropriate tests. However I do think you should recommend a Cardiology consult. The fact that she has known valve issues coupled with a concerning family history evidences this. Available tests include a stress test(MPI), coronary angiogram or utilizing a cMRI- choices are there...plus more based on symptomology. Your job is to advocate for her, and sounds like she is asking for some education- Good luck.