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Heart & Cardiology/reasoning for specific types of stress tests

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Question
Hello Dr. Richardson,

Recently, I had an event of chest pain and tachycardia. Paramedics thought depression in V4 V5 so took me to ER. ER EKG showed no depression, but I was kept for 24 hr observation & scheduled for out patient stress test and echo.

Echo showed nothing remarkable. Stress test showed something slight upon inclination, but I was told that sometimes regular stress tests show false pos there for women.

I have no family history of heart disease (a mother with a-fib), cholesterol 175. Cardiologist said I could go for a nuclear stress test, but could also wait and monitor condition, and call if I experience any more chest pain, particularly with exercise.

In 2002 I had an echo stress test (chest pain, anemic, mild murmur)in another state so different cardiologist.

I understand that both echo-stress & nuclear stress provide more accurate information. Nuclear stress with radiation sounds a little scary to me, so I took the wait and see option.

What is the benefit, or different reasoning to schedule a nuclear stress vs. echo-stress? Had this dr suggested an echo-stress option now, I probably would have taken it just to be sure, yet I forgot to ask why nuclear would be needed vs echo-stress.

Thank you in advance for your time.

Answer
Hello Katherine,

Echo and nuclear stress tests are equally sensitive.  The amount of radioisotope injected for a nuclear stress test is minimal, less than a chest x-ray, but it has no benefit over echo in sensitivity.

Please write back if this note doesn’t answer all your questions.

David Richardson

Heart & Cardiology

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David Richardson

Expertise

Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.

Experience

Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Organizations
Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Publications
Circulation, American Heart Journal, Hypertension.

Education/Credentials
M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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