Heart & Cardiology/Positive stress echo


Had a positive stress echo and my Dr.wrote:  "your stress echocardiogram has an area where there is some abnormal motion in the heart. This can be a false positive test, and you may be perfectly fine. On the other hand, this could represent a small amount of coronary artery disease.

The fact is that your cholesterol numbers are excellent, you do not have high blood pressure, and you are at very low risk of heart disease. Of female patients your age with your cholesterol, 97% of them will not develop any symptomatic heart disease over the next ten years. That said, we do have your symptoms of chest pain on exertion as well as an abnormal stress echocardiogram.

I recommend a coronary angiogram which will settle the issue. If this study is normal, I would take no further action and assume that your chest pain was not from the heart and was a false positive stress echo, and nothing ever needs to be done again in all probability. If there is some mild coronary artery disease, I would ignore it and simply add a dose of Lipitor to your medications. In the event that there is a significant blockage, I would have the cardiologist place a stent."

To clarify, I reported a tight/cold feeling in my shoulders, jaw and ears when walking my first hill of a long walk every day  On the subsequent hills I never felt a thing.  I did not have shortness of breath or chest pain.  He needed to say chest pain for insurance purposes.

My concern is the latest info about stents being overprescribed and not preventing heart attacks/death, and of course am very worried about such an invasive procedure even though I have been told it is the gold standard.

I would appreciate your opinion as to a next step.  I would also appreciate any questions I should ask my cardiologist.

Thank you so much in advance.

Hi, http://myheart.net/articles/do-i-need-a-stress-test/ http://myheart.net/articles/stent-save-life/

You ask a good question, and the answer to it lies in your clinical presentation. If you are high risk then the coronary angiogram is often a way to go, this is in patients felt to have unstable symptoms, progressively much worsening symptoms, or heart attacks. If you are low or intermediate risk then risk stratification tests are performed such as stress tests. The point of the stress test is two fold. Firstly it can provide data as to the extent of the problem, and secondly it can put you in a risk category. If it is a low risk category or a low-medium then often medicines can be used and the response assessed. Its not standard to be aggressive in the management of low risk tests.

Your doctor would have listened to your story and determined you to be at a certain risk. If he feels this is high he may be inclined to cath you to see the extent and location of any blockages to help further management, If you had a normal stress test then that would have been very reassuring.

I would ask the question, did i have a low, medium or high risk stress test? If it is low, ask why you are pursuing further management, if he says it is on grounds of presumed clinical instability or concern then he/she clearly has their reason to pursue further invasive testing but you should understand that better prior to proceeding, The test itself, if done in trained hands, is although invasive, relatively low risk.

In terms of stenting thats a whole different question, and typically that can be a discussion that is had at the time if there are at concerns, furthermore there are relatively stringent guidelines in place to prevent unnecessary stunting in this day and age.

Hope that was helpful,  

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Mustafa Ahmed MD


Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease


Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology


Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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