Why would my angiogram doctor want to transfer me to the surgical hosp

Posted by Barry @farnham, Nov 26, 2023

My cardiologist set up a catheterization angiogram at a local testing center to determine the level of blockage.
The procedure revealed blockage in at least 3 arteries, and recommended bypass surgery.
However, the center wanted to immediately transfer me via ambulance to the surgical hospital, the same day before I had even seen the potential surgeon.
I refused, pointing out that is was a Friday afternoon and even if the hospital admitted me, nothing would ne done over the weekend, or later until an with the surgeon was obtained and the surgery scheduled.
Anybody have this attempted? Seems to be a scam to charge the $8000-10000 for an unnecessary ambulance trip.

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Without having been a fly on the walls where various conversations took place that were directed toward your case, it's really hard to tell. What degree or percentage of blockage, and which arteries were involved. If the anterior descending was one of the three, yeah, I could see them having some urgency and wanting you to get to see a surgical team, maybe even over the weekend. Also, there's the symptoms; what are we talking about? Severe and intractable angina, some dull radiating pain toward the armpits, shortness of breath........what?
I'm not suggesting you were wrong to refuse their advice. But I don't know enough to argue for you or against you. Did they agree that you wouldn't likely go under the knife until the middle of the week?

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@gloaming

Without having been a fly on the walls where various conversations took place that were directed toward your case, it's really hard to tell. What degree or percentage of blockage, and which arteries were involved. If the anterior descending was one of the three, yeah, I could see them having some urgency and wanting you to get to see a surgical team, maybe even over the weekend. Also, there's the symptoms; what are we talking about? Severe and intractable angina, some dull radiating pain toward the armpits, shortness of breath........what?
I'm not suggesting you were wrong to refuse their advice. But I don't know enough to argue for you or against you. Did they agree that you wouldn't likely go under the knife until the middle of the week?

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My symptoms were mild. The surgeon's office was contacted for an appointment on that day. There was no emergency, but urgency. My angina was slight. I called my cardiologist and she prescribed a nitrate to provide help until I could meet with the surgeon.

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Okay, on that basis, I can hope that you did the right thing....for you. But, I still can't answer your question about 'scam.' About all you have done is borne the risk and saved yourself the cost of several nights and days in hospital...which is not inconsequential to the heavy majority of people posting here.

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Well, I can see the need. Let's take this to the point of view of the testing center. In this age of lets sue everyone for malpractice you will be surprised how a little thing can become a big thing quickly. Ill take this opportunity to tell you about the beginning of my journey to Heart Transplant. It began with a Flu Bug that I kind of ignored longer than I should have. I went to urgent care one week early in the week. The doctor suggested seeing a cardiologist soon and put me on the 5 day antibiotics pack they call it. My main symptoms was regular flu symptoms plus what I thought was major congestion. I would feel a bit out of breath when I laid down. So after a few sleepless nights I started sleeping sitting up as I could breathe easier. Plus taking a decongestant to hopefully breathe easier.
Well by Sunday that week I could not lay down at all and decided I needed to go to the ER. Well that started a chain of events which I ended up with a pacemaker and a enlarged Heart. The reason I was having trouble breathing was that fluid had built up around my Heart and Lungs. Which with the heart pushing against the fluid caused the enlargement. The one muscle you don't want large is the heart muscle. Plus, I found out its actually easier to breath sitting up than lying down. well after about 10 years of ablations, medication, difibulator shocks etc My heart was beyond help and I had a transplant. The reason I mention this is if I had taken the urgent care doctor more seriously, I may still have my original heart. I was more concerned about missing work ( I had just started a new job I loved) than doing what I should have and seen a cardiologist sooner. I did make an appointment but ended up in the Trama center before the appointment day arrived.
Please know I hope your fine and it all works out, but as they say Hine-sight is 20-20. BTW the cost of the transplant & 1 year of appointments cost my insurance company almost 1 million Dollors. That does not include the 2 pacemakers, 8 ablations and appointments 4 times a year for the 10 years leading up to it. Thank God for Insurance but either way my cost was not cheap either. at a guess about 35,000 for the transplant, each ablation was about 2000 out of pocket. I would have gone to the Hospital.

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Thanks to all the opinions and observations. Almost all of the doctors and organizations contributing to my path toward correction of a lifelong and hereditary fault in my heart, have been very beneficial.

I now have a schedule for surgery with the best in the area. When we were in the office, we heard another patient describing a similar situation, where the testing center transferred them to the hospital directly and the hospital refused to admit without a valid surgery order from the doctor.
I am not sure why the testing center tried this, except they seemed to want credit for extending an out patient procedure to the surgical admission.

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@danab

Well, I can see the need. Let's take this to the point of view of the testing center. In this age of lets sue everyone for malpractice you will be surprised how a little thing can become a big thing quickly. Ill take this opportunity to tell you about the beginning of my journey to Heart Transplant. It began with a Flu Bug that I kind of ignored longer than I should have. I went to urgent care one week early in the week. The doctor suggested seeing a cardiologist soon and put me on the 5 day antibiotics pack they call it. My main symptoms was regular flu symptoms plus what I thought was major congestion. I would feel a bit out of breath when I laid down. So after a few sleepless nights I started sleeping sitting up as I could breathe easier. Plus taking a decongestant to hopefully breathe easier.
Well by Sunday that week I could not lay down at all and decided I needed to go to the ER. Well that started a chain of events which I ended up with a pacemaker and a enlarged Heart. The reason I was having trouble breathing was that fluid had built up around my Heart and Lungs. Which with the heart pushing against the fluid caused the enlargement. The one muscle you don't want large is the heart muscle. Plus, I found out its actually easier to breath sitting up than lying down. well after about 10 years of ablations, medication, difibulator shocks etc My heart was beyond help and I had a transplant. The reason I mention this is if I had taken the urgent care doctor more seriously, I may still have my original heart. I was more concerned about missing work ( I had just started a new job I loved) than doing what I should have and seen a cardiologist sooner. I did make an appointment but ended up in the Trama center before the appointment day arrived.
Please know I hope your fine and it all works out, but as they say Hine-sight is 20-20. BTW the cost of the transplant & 1 year of appointments cost my insurance company almost 1 million Dollors. That does not include the 2 pacemakers, 8 ablations and appointments 4 times a year for the 10 years leading up to it. Thank God for Insurance but either way my cost was not cheap either. at a guess about 35,000 for the transplant, each ablation was about 2000 out of pocket. I would have gone to the Hospital.

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Thank you for your response. The angiogram was ordered by my excellent cardiologist as the next step toward a Medicare and insurance supported path. My age, family history, and increasing symptoms led me to pursue this course.

I believe this pursuit has identified the need early enough to avoid more serious damage to my heart. My heart is strong, my lungs are clear, and although I have not had any more serious symptoms, it is my hope that bypass surgery and continued diet and lifestyle monitoring will extend my heart health for a number of years.
Living healthy into our 70s is a full time permanent job.

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@farnham

Thank you for your response. The angiogram was ordered by my excellent cardiologist as the next step toward a Medicare and insurance supported path. My age, family history, and increasing symptoms led me to pursue this course.

I believe this pursuit has identified the need early enough to avoid more serious damage to my heart. My heart is strong, my lungs are clear, and although I have not had any more serious symptoms, it is my hope that bypass surgery and continued diet and lifestyle monitoring will extend my heart health for a number of years.
Living healthy into our 70s is a full time permanent job.

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I'm still wondering why the Angiogram tech felt it was a more immediate problem. Has the cardiologist informed you of what the test showed? I myself probably would be so curious as to the urgency to find out what my cardiologist thought. As for the need to convince my insurance, for me that was all done in the hospital during my evaluation. So anyway, I myself would be really wondering why the testing center was so concerned.
I would love to hear more as to your journey, and you are very wise to be paying attention to diet and lifestyle changes.
Blessings to you as you continue on this journey. Please let me know if I can help with any questions.

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@farnham
My husband had a similar experience- 11 years ago on Friday of Memorial Day weekend. He had an appointment with his cardiologist regarding some “ mild” symptoms with activity- tennis.
The doctor arranged for a cardiac cath at the hospital at once. My husband wanted to go home and come back after the holiday. The answer was no.
The cardiac cath showed blockage of 3 coronary arteries. The cardiothoracic surgeon was called and my husband had a triple artery bypass right after the cath.
I understand your reluctance using an ambulance for transportation to the hospital-
Driving alone would not be the ideal.
With the blockage found in your coronary arteries there is no guarantee that you would be fine waiting.
My husband had not met the surgeon before either but the cardiologist recommended him and my husband trusted his cardiologist.

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The cardiologist was probably being cautious. With three different blockages, depending upon degree, you are probably high risk for a heart attack and I think any procedure can stir things up. Not sure what you mean by testing center and surgery center. Are these places other than a hospital? My interventional cardiologist did my angiogram at the hospital, with a possible overnight stay. Turns out I had more testing in anticipation of having more work done on my heart other than just the graft. A couple of things with my arota needed fixing. I was quite happy to have this done at the hospital. If I hadn't had insurance coverage, I might have preferred to come back for the additional testing, rather than stay as an in patient.

A friend of mine in another country was having a procedure in which the docs were going through the groin to place a stent or do an angioplasty. Good thing he was at the hopsital. Things got blocked and he need emergency open hear surgery. He might not have survived an ambulance ride.

I don't thin it is a scam on the part of the testing center. The ambulance trip is paid to the ambulance company, not the testing center. And $8000+ for an ambulance trip? Are they made out of gold where you are?

Hope all works out well for you.

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@danab

I'm still wondering why the Angiogram tech felt it was a more immediate problem. Has the cardiologist informed you of what the test showed? I myself probably would be so curious as to the urgency to find out what my cardiologist thought. As for the need to convince my insurance, for me that was all done in the hospital during my evaluation. So anyway, I myself would be really wondering why the testing center was so concerned.
I would love to hear more as to your journey, and you are very wise to be paying attention to diet and lifestyle changes.
Blessings to you as you continue on this journey. Please let me know if I can help with any questions.

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As mentioned in a previous reply, I got an appointment with the surgeon 5 days after the test. The surgeon reviewed the images and began scheduling for the bypass surgery.

My regular cardiologist gave me a prescription for a nitrate to address the mild angina while waiting for the surgery. The surgeon is one of the best here. He said that bypass is urgent, but not an emergency. My hospital would not have admitted me if I had been sent before seeing the surgeon, which is exactly what happened to another patient who had been sent directly from their test.

At any rate, I am on track for surgery and will go in for preoperative testing in a week.

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