What is the risk of avoiding or postponing angiography?
Patient's Query
Hi doctor,
I am a 45-year-old male. My height is 6 feet, and my weight is 213 pounds. I have breathlessness on exertion. I get some pain in my throat while walking, but not always. I had a TMT test, which was positive. I did TMT for 6.3 minutes and stopped due to breathlessness. The ECG showed ST depression of 2.5 to 3 mm in the inferolateral leads.
My father, who is now 80 years old, has had some ischemic issues and has been on medication for about two decades. My echo was normal with mild LVH. The ECG showed ST depression and T-wave inversion first; later, the T-wave inversion went away and again came back. Similarly, it showed LVH with strain earlier, and now it does not. I suffer from severe sleep apnea (AHI index 62) and oxygen desaturation up to 50 percent while sleeping.
I am unable to use the CPAP machine due to discomfort while using. My LDL was 153 mg/dL, and with medicine it is 90 mg/dL now. My HDL is 39 mg/dL, triglycerides are 129 mg/dL, and lipoprotein (a) is 68 mg/dL. I never had diabetes all these years, but in my last blood test, the HbA1c was 6.2 % that is prediabetes.
My recent blood work also shows changes in MCV (106), MCHC (27.9), RDW-SD (64.4), and RDW-CV (16.7), as well as SGOT (38.1) and SGPT (48.6). I have been advised to take Sorbitrate, Ecosprin AV, Dilzem and Deriphyllin by one cardiologist. He asked me to try out these before taking further tests. Another cardiologist advised an early angiography.
- Do I need angiography immediately?
- I would like to avoid invasive procedures. What is the risk of doing an angiogram?
- What is the risk of avoiding it or postponing it for several months?
- My ECG showed ischemia earlier, but then it seems to have gone away. Does this indicate that the medicines have cured it?
- Similarly, earlier I had RBBB and not now. The same with LVH. Is it possible that a blockage in an artery can cause constriction in the throat?
- Could my TMT be a false positive?
- Should I repeat it?
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I want to reassure you that there is no need to worry; everything will be fine with the proper care and treatment. I have carefully reviewed your case and understand your genuine health concerns. I am sorry to hear about your health issues, but please do not panic; there are solutions for every problem you face.
Let us address your queries one by one. Based on your medical records, you need an angiography (a medical imaging procedure that visualizes blood vessels and organs) immediately. Please don’t be anxious about the procedure; you will only feel a small prick from a standard needle, similar to ones you have had before. The rest of the procedure is painless. You will remain conscious, without the need for general anesthesia, and you will be able to listen to the doctors while watching the images of your heart’s blood vessels on the screen.
While risks are associated with any medical procedure, angiography typically has no major risks. Minor risks may include heart attack, artery injury, irregular heartbeats, stroke, allergic reactions to the dye used, radiation exposure, kidney problems, bleeding, and post-procedure infections. Delaying the angiography may not seem serious, but it could lead to a sudden cardiac event with potentially life-threatening consequences. Therefore, I strongly advise you to proceed with the angiography without delay.
Changes in your ECG (electrocardiogram) can occur, but often do not result in complete resolution with medication alone. You have left ventricular hypertrophy (LVH), albeit mild, which could worsen if not addressed promptly. Symptoms like neck constriction and shortness of breath suggest partial blockage in the heart’s vessels. Additionally, your sleep issues are also significant indicators of coronary artery disease and LVH, which could lead to congestive heart failure if untreated.
When your body requires more oxygen during physical activity or emotional stress, the heart must work harder to meet this demand. However, due to partial obstruction, the heart's blood supply is insufficient, leading to symptoms like neck constriction and shortness of breath. Your chest pain, which occurs even at rest, is particularly concerning, as this indicates a more significant obstruction.
There is no need to repeat your exercise stress test; instead, proceed with the angiography. If it shows blockages, angioplasty (a procedure to open narrowed or blocked blood vessels, usually in the heart) can often be performed immediately during the same procedure, effectively addressing the issue in one go.
I hope this helps.
Please revert so I can assist you further.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
Thanks a lot for your detailed and step-by-step answer. It is great to see an expert spend so much time allaying the fears of a patient. I propose to have the angiogram in a week or a fortnight's time. Meanwhile, I seek your guidance on another couple of queries. My cardiologist proposed to do it through the radial artery in the wrist. When my father had angio sometime back, it was through the femoral artery (groin).
- How does the radial approach compare with the femoral in terms of pain and safety?
- Is there any chance of an artery getting ruptured by the catheter?
- Is there any specific precaution to take until the angio is done?
- Will a CT angio (256 slices) be of any help?
- How to lower my lipoprotein (a), which is high and is said to be a risk factor for cardiac disease?
Please help.
Thank you.
Hi,
Welcome back to icliniq.com.
It is common to feel anxious about cardiac issues, especially regarding catheterization. There is no significant difference in complications between the femoral and radial techniques. While specific preparations for angiography are not extensive, it is best to avoid strenuous exercise or activities that might cause chest pain, like running.
CT (computerized tomography) angiography has innovative clinical applications, especially in complex cases. It provides a wide range of images through advanced detectors and 4D CT subtraction, minimizing artifacts during the heartbeat. This scanner offers fast and high-quality "triple-rule-out" test results without requiring large volumes of contrast dye, allowing for a comprehensive view of the heart's blood supply without stair-step artifacts common in older systems.
It is important to note that lipoproteins and lipid profile abnormalities are risk factors for heart disease. While exercise, diet, and lifestyle modifications are essential for maintaining healthy lipid levels, in your case, exercise may put extra strain on your heart. Focus on a healthy diet; avoid added salt, sugar, fatty meals, fried foods, and beverages like tea, coffee, and energy drinks. Instead, include fish, vegetables, salads, and fruits.
If these measures do not improve your lipid profile, consult your cardiologist about medication. Please proceed with coronary angiography.
I hope this helps.
Please revert so I can assist you further.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
I have scheduled an angiogram.
- In case a block is found in the angiogram, can it be treated later in a separate procedure?
- Based on my medical reports, what are the chances that a block will be found?
- Based on my reports, do you feel that it is likely to have a block?
Please help.
Thank you.
Hi,
Welcome back to icliniq.com. Providing specific advice without a physical evaluation in the office is challenging. However, it does seem that angioplasty may be necessary due to coronary artery disease. You can schedule angiography later if needed; it's not mandatory to have angioplasty during the same visit. If there is significant blockage, the medical team will advise you accordingly.
You might have very mild disease that requires only medication. In cases of triple vessel disease, patients may need coronary artery bypass grafting (CABG). The appropriate treatment depends on the specifics of your condition. For further guidance, I recommend consulting a cardiologist.
I hope this helps.
Please revert so I can assist you further.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
Cardiology
Related Questions
Triple Bypass Surgery - Indications and Procedure
Is angioplasty required if triglyceride levels are high?
Quintuple Bypass Surgery
Which angiogram, MR or CT, will show a brain aneurysm?
Can angioplasty help in maintaining heart function?
Is angiogram necessary for a 72-year-old man with high blood pressure and cholesterol?
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.