When is an angiogram called for?

Posted by jchp @jchp, Dec 20, 2017

I am female, 68 with HCM, diabetes, HTN, hyperlipidemia,unable to take statins or Beta blockers....So high risk for Coronary Disease. I do take calcium channel-blockers and baby aspirin. Chest pain is common with HCM.... The only reason I know I have coronary artery disease is that I had a coronary angiogram 5 years ago before open heart surgery for a septal myectomy. I have a 40% lesion in RCA and 20% lesion in LAD ( 5 years ago anyway)... which do not qualify for stenting. . Since I still get chest pain on and off I had a pharmacological stress test recently and it was negative. I still have this eery feeling that they are missing something and would like to get a stent before a heart attack rather than after......but my cardiologist doesn't feel an angiogram is warranted with a negative stress test. Has anyone been in this position? The doc says the danger is plaque breaking off not that the blockage will increase.... and that there is no test to really predict when a piece of placque might break off.
Look forward to any insights

Interested in more discussions like this? Go to the Hypertrophic Cardiomyopathy (HCM) Support Group.

Colleen Young, Connect Director | @colleenyoung | Dec 22, 2017

Hi JCHP, welcome to Connect.
I moved your message to the Hypertrophic Cardiomyopathy (HCM) group so that you can connect with other members who have been diagnosed with HCM and who may be able to respond to your question about when in an angiogram called for in the context of HCM. Please meet @rmwundrow @cynaburst @PatMattos @Sensation @ronaldpetrovich @FrancineFafard @lisa7 @janicepike and @debcrawford to name a few.

JCHP: I encourage you to read through some of the other discussions of the HCM group too: https://connect.mayoclinic.org/group/hypertrophic-cardiomyopathy-hcm/
I can imagine that you must be nervous given that you still have chest pain on and off. Does your doctor feel that the risks of an angiogram outweigh the possible benefits?

Cynaburst, Alumna Mentor | @cynaburst | Dec 22, 2017

In reply to @colleenyoung "Hi JCHP, welcome to Connect. I moved your message to the Hypertrophic Cardiomyopathy (HCM) group so..." + (show)

It sounds like your issue is more with CAD than with HCM. Chest pain is of course common with HCM, but is not caused by the same type of blockage as CAD. I think that your question is really one that is more directed at patients who have coronary artery disease since angiograms and stents and this type of stress tests is not generally used in HCM.

In any event, if you are having chest pain and have HCM, but don't have sufficient criteria for a stent, maybe your symptoms are instead being caused by HCM. Are you being seen at a HCM specialty center like Mayo. They could help you sort out the cause of your pain. It seems to me that is a crucial difference that you need to sort out before making any treatment decisions.

Sensation | @Sensation | Dec 23, 2017

Hi jchp. I can't offer much feedback cause I don't have Coronary Artery Disease, but I had a Nuclear Stress done not too long ago for Chest Pain that's been pretty unbareable at times, and I have Apical HCM, so it's hard to tell if something is wrong unless the chest pain gets super bad. It got so bad it felt like I was hit in the chest by a semi or a train. Anyways I when I had the Nuclear Stress Test done the Cardiologist said that there was a spot they found that was causing lack of blood flow to my heart but they don't know if it's a blockage so the only thing to do is to take it to the next step & that was to have an Angiogram, so I had an Angiogram done & it turned out that there was no blockages or plaque. So I'm thinking it was probably HCM related, but unfortunately I can't really afford to see my Cardiologist Specialist at the Mayo Clinic so I just gotta live with it for now. I really hope you do find some answers. I know exactly how it feels to be in the dark about what's going on...it sux!

rostrevor | @rostrevor | Jan 22, 2018

Why not get a CT angiogram scan which is nonevasive and will show any blockages. Only negative is if there are blockages you will need a real angiogram so the blockages can be removed or stents put in.

Kanaaz Pereira, Connect Moderator | @kanaazpereira | Feb 5, 2018

Hello @rostrevor,

Welcome! Thank you for your suggestion and advice; may I ask what brings you to Connect? We look forward to getting to know you.

rostrevor | @rostrevor | Feb 5, 2018

I had a quintuple bypass 8.5 years ago in Canada and have been very active since playing tennis and baseball at 73.I visit the Mayo in Az often yearly for some check ups and blood work although I see my various specialists back home as needed.