DEAR DR. GOTT: I’m a fairly healthy 51-year-old male. My only ongoing issues are some allergies that are being addressed and mild to moderate sleep apnea for which I use a CPAP. In early June I started a new job at a wellness company and began exercising – mainly brisk walks for at least 30 minutes – more regularly. I eventually felt comfortable to jog (20%) and walk (80%) a 5K dressed (because it was themed) in an Elvis jumpsuit. I completed it in about 45 minutes.
The following week, I started feeling some chest pains when I’d exert myself. After I’d rested for a few minutes I would be okay. My doctor did an EKG and saw a couple of slightly unusual dips/jumps so he ordered a stress test. The cardiologist monitoring the stress test saw nothing heart-related despite the fact that my pain gradually increased as the incline and pace of the treadmill were raised. An agent was inserted in my blood near the end of the test and after resting for a while they took some “photos” of my heart with a nuclear camera. Nothing of concern showed up.
When my doctor got the results several days later, his office relayed that it didn’t appear to be a heart problem (although my father and two of my three brothers have had heart issues), but if I was still feeling symptoms, I should make an appointment with a particular cardiologist. When I got in to see him almost a week after that, he grudgingly said we could do an angiogram. I was made to feel that it might not be necessary, however. I went ahead anyway and a 95% blockage was found in a major artery. I was told that I could have suffered a severe, or massive, heart attack if this hadn’t been addressed. I had a stent put in at the time of the angiogram as well.
My question to you is, how common is it for stress tests and nuclear camera “photos” to show nothing unusual but to actually have a significant blockage like this? I was very, very lucky, I know. If someone else can avoid a heart attack by having an angiogram in these kinds of circumstances, it’ll be worth writing this letter to you.
DEAR READER: Coronary heart disease (also known as coronary artery disease), which involves blocked coronary arteries, is the most common cardiac condition and, unfortunately, is the leading cause of death among both men and women in the US. This is likely what you have.
Atherosclerosis occurs when an artery becomes blocked with plaque (which is made up of fat, cholesterol, calcium and other blood substances). In some instances, this is often a result of poor diet and exercise habits; however, in others,\ — even with ideal diet and exercise — buildup can still occur. This is likely due to hereditary causes. You have a strong family history of cardiac problems so this may play a role. Without knowing your previous diet and exercise regimen, I cannot say whether this was a related factor or not.
Now to answer your question and address your concerns. Your EKG (electrocardiogram) clearly showed some abnormalities so your physician was correct to recommend a stress test which required walking at increased speeds and inclines in order to view and monitor how the heart is beating and the blood is pumping during exercise and afterward.
Given that you had a tracer, which dilates the blood vessels to make them more visible on camera, its my guess that you had a sestimibi stress test. It is the most commonly performed.
Blockages don’t always cause symptoms and minor ones can sometimes be missed; however, you had a significant blockage. I find it hard to believe that nothing abnormal was noted, but that isn’t to say it didn’t happen. Perhaps you’ve had the blockage for quite some time and your body has compensated for it by nearby arteries taking over.
Whatever the case, you were correctly referred to a cardiologist in the event of further symptoms. Based on your letter, it appears the specialist wasn’t very concerned and was fairly dismissive of your symptoms. Thankfully, although reluctantly, he did recommend the angiogram,. It is somewhat frightening to think what might have happened had he dismissed you out-of-hand and you had returned to your normal lifestyle. I can only hope that your cardiologist learned an important lesson by treating you that he will remember for the remainder of his medical career.
Remember to reduce your intake of animal fats, red meats, cholesterol, whole milk dairy and more. Exercise daily. Keep stress to a minimum. And, finally, follow your physician’s advice regarding medication and supplements.
Anyone who has symptoms that cause concern should speak with his or her physician(s) immediately. Make them listen, or find a doctor who will. If you believe there is something wrong with your body, chances are, there is. It’s just a matter of finding a doctor who will believe you and work with you to get to the bottom of the problem.
Readers who are interested in learning related information can order my Health Report “Coronary Artery Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.
