What are basic tests a cardiologist can do?

I am seeing a cardiologist who I believe is being negligent, what can I do? [LONG POST]?

• It all started last May. I woke up in the middle of the night and i could 'feel' my heartbeat all over my body. Very strange feeling. Not beating fast, not slow, just HARD and very prominent. Was a little concerned but shrugged it off and ended up falling asleep. Woke up the next morning and the sensation was gone. It however returned the next day when at work i got a bit heated in an argument with a colleague. From that moment the sensation never left me. Can always feel my heartbeat. I went to my GP and he checked me out and said it was anxiety/in my head. Accepted it then. Time went on and it persisted and got even stronger so my GP sent me to a cardiologist who did an echo, stress test and holter. All normal except stress test, showed moderatley reduced exercise capacity. Was acceptable at the time as i was and have always been very unfit. About 3 months after this started, i begun getting chest pressure feelings everytime i would climb a flight of stairs at my work. Shrugged them off at the time but they persisted, So i googled it and it came up as angina so i went to my GP again and ordered another stress ecg. This time however i only completed 5 minutes as I attained my Maximum HR 'too quickly' and became short of breath almost immediately. Did not experience chest pain however, and because of that, they believed a respiratory issue was the cause. Went and did all my lung tests which showed NO pulmonary problems at all. I continued expressing my concerns about my chest pressure when climbing stairs and on rare occasions, a small pain in the centre of the chest which lasts about 3-5seconds accompanying the pressure. In the end I was referred back to another cardiologist who i expressed these concerns to and he prescribed a dose of atenolol and ordered another Echo. Just completed the echo today which came out 100% perfect, as it was last time. Despite me telling him about my chest pressure climbing stairs, all he said was 'there are many causes for a fast HR' i think he wants to pin something like "innapropriate sinus tachycardia" on me and dismiss me. After a bit of an argument, he ordered another stress ECG for next week and said that 'he wants to supervise this one" and on top of that, he told me to TAKE A BETA BLOCKER for the test. Now even i know that all cardiac medications should be stopped prior to heart tests as they can affect the true results. He kept saying 'if you had an occlusion in an artery it would show up on a stress test' but i know thats not always the case as i have read alot of people who go for cardiac stress tests and actually PASS it and still have symptoms,and they at some stage get a catherisation performed on them and they find things like 90%blockages in arteries. I'm concerned i have a blockage causing all these symptoms and nothing will get done about it because of my situation. I am 21, male, and normal weight & had plenty of blood/thyroid and urine tests which come out fine. Even cholesterol came out as the doctor phrased it "Better than 90% of australian population, HOWEVER, what's left me paranoid about an artery issue, is that for 3 years straight i ate nothing but fast food for breakfast, lunch and Tea. NO JOKE, EVERYDAY for 3 YEARs. As i was living on my own and loved fast food. I never exercised or participated in PE ever since a little kid. I believe i have an atypical case of a blocked artery and am concerned that it will not be treated. If I do this stress ECG and no ischemic changes show up on the ECG, then i'm positive that my doc will dismiss me. What should i do in this case? Do i have a right to request a heart cath? if not, can i report him somewhere as being neglegent? or can i request another opinion from another cardio, if so how do i do it?

• Answer:

  1. It sounds like you're out of shape and tire easily on exertion. Your chest pain could simply be the result of your heart being worked to the maximum, not necessarily ischemia. 2. You want a doctor to thread a catheter into your heart for your complaints, when there is NO PHYSICAL EVIDENCE? Please understand the dangers of this procedure. I encourage you to look it up and read more. Invasive cardiology procedures are not done on people with no physical evidence of anything wrong for very good reasons. In fact, he'd be really really hard pressed to find an invasive cardiologist willing to stick a cath in your heart. 3. YOUR DOCTOR IS NOT BEING NEGLIGENT. HE KEEPS ORDERING TESTS AND IS OBVIOUSLY TRYING TO RULE OUT AN ISCHEMIC CAUSE FOR YOUR PAIN. 4. YOU DON'T APPEAR TO HAVE ANY RISK FACTORS FOR ATHEROSCLEROSIS. You are young, your cholesterol is not high, your blood pressure is not high, you don't smoke, you don't have diabetes. If you have a family history of heart attack or stroke, that's 1 measly risk factor. 5. Have you been evaluated for exercise-induced asthma? Along with anxiety, these are the only things I can think of to explain your symptoms which would not be seen on EKG or echo. If your EKGs are normal, your Echos are normal, and your bloodwork is normal, there's no reason to send you for a risky, expensive procedure. You don't have any evidence of ischemia, heart failure, pulmonary edema, etc. You are at a very low risk for coronary artery disease, despite your poor diet. 3 years of eating crap food at your age, without other risk factors, does not cause atherosclerosis. If your diet was contributory, you would have had elevated cholesterol, that's the mechanism by which diet leads to artery disease. Sorry if this sounded snotty, but you need to seriously reconsider your attitude toward this cardiologist. He's obviously doing everything he can to help you, even wanting to supervise the stress test, which they don't normally take the time to do.