Failed treadmill stress test...

A quick question for any the Medics in here.....

Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's in 2001, Angioplasty and 4 stents implanted. Since then recurrent bouts of unstable Angina resulting in 14 hospitalizations, (Angiogram shows all clear) several goes at Clot-busting drugs, but no more actual Mi's. Taking Ramipril, Statins,
Clopidogrel, Asprin, Diltiazem and Nicorandel.

I failed my regular treadmill stress test (9-stage Bruce) today. There were no noticeable changes to the ECG, nor any unusual variations in BP. I just had a great deal of pain (nearly passed out) and had to stop the test entering stage 4. The technician was a little confused, thinking it might be something other than Angina, and the Doctor had very little to say to me.

I guess this was exercise-induced angina, it certainly felt like it, and
GTN soon stopped the pain, but why were there no other indicators ??

You could gather the more objective information from the angiogram report and post it to the group as a clarification. "Clear" isn't exactly a precise medical term. I'm sure someone like Dr. Chung could confirm whether the angiogram demonstrated anything to be concerned about or not.

(with past history of angioplasty and 4 stents, it be would unexpected for your angiogram to be all clear)

One possibility is that the culprit vessel is a tiny one that supplies only a tiny amount of heart muscle that is too small to either visualize with nuclear imaging or detect with the EKG.

Servant to the humblest person in the universe,

I would phrase it as follows:

"Your prognosis is likely good. There is nothing that can be done in the way of interventions to relieve your symptoms. However, medications and other measure to lower risk factors will remain quite effective in preventing your next heart attack and/or stroke."

With only "direct physical treatment" and no medical treatment to lower coronary risk factors, they will deteriorate.

This reminds me of the 2PD approach

Servant to the humblest person in the universe,

Wonder why your references are all one-sided (nearly all have Gould as an author).

Servant to the humblest person in the universe,

Might be a reason for B´adant and the rest of us interested medical-laymen to search for additional references and sources to keep us educated/informed about the subject.

Not really - I am not treated by any one specific Doctor, but rather a team at my local Hospital in the UK.
The follow up Angiogram was done roughly 6 months after the original stenting to check that they had not failed, and they hadn't - that's all I was told.
It's a shame, but it's not until after you get home and are feeling better do you think of asking more in depth questions, and getting to see a specialist on the NHS when it's not an emergency is almost impossibe, especially if you simply want to ask questions....

I just wonder why the intense pain I felt during the test did not register on any of the equipment...

You would be well advised never to refer to it, even if you think you need it.

Servant to the humblest person in the universe,

Not a doctor, but:

- when was the angiogram done?
- can you provide more specific objective results (vs. "clear", for example, the % that each of your coronary arteries are clear/blocked?

Terrific info easily understood, Sonos. I've printed this and hope I never have to refer to it.

I would call that hospital, and ask for a copy of the report from the angiogram ... although since it was done some time ago ... I don't know how valuable it would be. If it was long enough ago, certainly things could have changed. And I'm not so sure that it would be reflected in your ECG ... although perhaps the Dr. can comment on this.

I would also ask the cardio who reviews your stress test what he/she recommends at this juncture.

I could ask for a copy of the Angiogram, but what would I do with it ?
I will ask what the cardiac docs think, I am due to return to them in a few weeks for review...

So, you think that I could have experienced intense Angina pain induced by the test, yet there are no visible signs on the equipment?
Is this something to worry about, or is it minor enough to be dealt with by medication?
Does a small vessel blockage have the same MI risk as a major vessel blockage?
Could there be several of these small vessels blocked, and if so, as there is no direct physical treatment, will they deteriorate?