Question about Echo Versus Stress Echo

[Guest]

My husband has had a Grade 3 heart murmur for a long time. Because his identical twin brother passed away several years ago of Idiopathic Hypertrophic Cardiomyopathy with Methamphetamine Toxicity, and because my husband has now received an abnormal EKG, his cardiologist has ordered an echo in 2 weeks. My husband SOMETIMES get chest pains and shortness of breath after physical exertion, but he has not had these symptoms lately, so we did not tell the cardiologist about them.

So, my question is that I am hoping the echo will be able to diagnose the problem because a stress echo will cost so much more. Do you think we should tell the doctor about these symptoms or just wait for the echo to be performed? Because if we do tell him about these symptoms, then he may order a stress echo, which will cost a lot more.

(Yesterday, my husband washed two cars and watered the lawn without any chest pains or shortness of breath. He then later walked around a casino for an entire night without any symptoms. So I just don't know if I want to tell the cardiologist about these symptoms that he rarely gets anymore because the standard echo is so much cheaper than the stress echo)

Thank you.

 

[pwoglom]

Absolutely, positively, unequivocally, without hesitation YES!

 

[Guest]

Yes to what? And, if possible, can you please provide a reason why? Thank you.

 

[ski girl]

I guess it all really depends how much your husband is worth to you.

Seriously, why are you even asking, considering the family history???

 

[DebbyA]

I think you should tell your cardiologist all his symptoms and all your concerns, including the cost factor. It sounds like the cardio is still looking for the structural cause of the murmur. If a stress echo is ordered, you could ask why it is a better choice. You didn't mention what was abnormal about the EKG or whether a valve problem is suspected. Candidates for valve surgery usually have an angiogram before surgery to check for coronary artery problems.

 

[AZ Don]

I think you should tell your cardiologist all his symptoms and all your concerns, including the cost factor.

I agree with this completely.

 

[dornole]

Docs can't make good decisions without good information. Tell them anything that might be related -- one bit of info can send their intellect and intuition in a whole new direction. My failure to provide accurate info had bad effects for me and I hope I've learned my lesson. Try to provide specific data as best you can. Examples from my experience:

BAD: I have a dry hacking cough at night. Sometimes I cough up a little blood.
GOOD: I have to sleep upright in a chair and I cough up quarter-sized splots of blood 1-2 times per day.

BAD: I'm tired but hey I'm pregnant right?
GOOD: I can't make it up one flight of stairs without having to rest.

Desire to feel/appear strong and hearty, not wanting to "bother" docs or fear of looking like a hypochrondriac / dumb are all traps to avoid. For sure doc NEEDS TO KNOW family history and should know about the past chest pain and shortness of breath. Try to get as specific as you can about how long since the last episode, what brings it on and severity. It is not fair to your doc or good for you to withhold info. It's hard enough to give them the data they need even when you are trying to be 100% open. It is up to them to go from there and if you let them know cost concerns and a decision is "on the fence," they can consider that too. But ultimately poor info is more likely to lead to unneeded and expensive testing than good info will. I hope you get OK news with a clear way forward.

 

[MrsBray]

Withholding information is the last thing you want to do. I'm in the process of selling my prized musical instruments to pay for health care. My health is more important than my bank account.

 

[Guest]

Thank you all for your feedback. I was able to fax today his cardiologist with the updated information about how he sometimes gets chest pains and shortness of breath after physical exertion, which he said started in his late twenties (he is 37 now). My husband did say that these symptoms have gotten better since starting Prilosec 7 months ago, but that he still sometimes will get those symptoms after physical exertion. We will now wait and see if his Dr. believes that a standard echo is fine, or if he suggests that we also do a stress echo.

DebbyA, his Dr. never said what was abnormal about the EKG, and he never mentioned anything about if he suspected a valve problem. He ordered an echo based on family history, abnormal EKG, and a pretty strong Grade 3 heart murmur. We will now have to see if he wants to do a stress echo based on the new info of my husband sometimes having chest pains and shortness of breath following physical exertion.

The doctor knows about our cost concerns, so I am sure he will take all of this into consideration.

 

[Guest]

MrsBray, I wish you all the best and hope everything works out!

 

[ski girl]

Don't worry too much about a stress echo - I had BAV all my life (40yo when I had AVR) and I never had a stress echo. I've now had two, but only because I demanded them. Reporting shortness of breath on exertion will probably be fine, he won't need to *prove* it.

When I was living in the US they wouldn't give me a stress echo at all because making valve patients exercise hard was considered not a good idea!

 

[Guest]

Ski girl, thanks for the feedback. I am very interested to see results of my husband's echo, which he will be having on 2/14.

 

[ski girl]

Valentine's Day - that's a good day for hearts!

 

[epstns]

Isn't February National Heart Month here in the US? I think it is, as I was happy to have moved my surgery up to Feb. 28 to get in on the action.

healthyheart, by all means, tell the doc all you can. Your husband is quite young to have chest pains after exertion without an explanation. Gastric reflux can mimic the pain of heart issues, but is not exercise-related. Trust me, washing cars and walking in a casino is not heavy exertion. Can he play active sports? Does he exercise at a gym? Run? Ride a bike? If so, and if he does so without pains, then maybe not a big issue. He may have, without realizing it, reduced his physical exertion levels to avoid pain that would otherwise occur. I'm not trying to paint a grim picture. I'm trying to suggest that you err on the side of conservatism and disclose all, then let the doc's do their jobs.

 

[Guest]

Hi Epstns,
My husband does not play active sports or go the gym, run, bike, etc. He is not into that stuff. I do notice that he gets chest pains after sex, in which he is exerting himself a lot. My husband smokes marijuana daily, as he says it relaxes him. So that "lifestyle" may go along with why he also does not like to do your typical exercises.

 

[pellicle]

excuse me for reading someone elses mail ...

Hi Epstns,
My husband does not play active sports or go the gym, run, bike, etc. He is not into that stuff. I do notice that he gets chest pains after sex

! .. blink blink .. looks again ... yep I did see that

My husband smokes marijuana daily, as he says it relaxes him. So that "lifestyle" may go along with why he also does not like to do your typical exercises.

and of course its probably too late to suggest he starts (and of course you should simply discuss this with a Dr as a first precaution).

Is there no "public health care" in CA?

Hardest shopping I ever did was in a semi-stunned state (after a long flight and a grueling time at the morgue) picking a coffin for my wife. I hope you don't find yourself in the same situation with your husband. He can still be turned around when he's alive, same can not be said after he's dead.

Best wishes

 

[ski girl]

Hardest shopping I ever did was in a semi-stunned state (after a long flight and a grueling time at the morgue) picking a coffin for my wife. I hope you don't find yourself in the same situation with your husband. He can still be turned around when he's alive, same can not be said after he's dead.

Well said pellicle.

 

[clay_from_nj]

Hi Epstns,
My husband does not play active sports or go the gym, run, bike, etc. He is not into that stuff. I do notice that he gets chest pains after sex, in which he is exerting himself a lot. My husband smokes marijuana daily, as he says it relaxes him. So that "lifestyle" may go along with why he also does not like to do your typical exercises.

(WARNING: The following reply to the above post contains tough love and a mild expletive!)

healthyheart-

I assume that you love your husband and want him around for a long time. KICK HIS ASS! There is no way to say that smoking of any kind won't have a detrimental effect on one's health. Get his ass off the couch! There are "lifestyle" choices and there is stupidly killing yourself, selfishly, and without regard for those who love you. Tell him how much you love him and how much pain he's causing you and how much pain you might cause him if he doesn't get his act together!

(And yes, you can tell him I said all that, word for word. What's he going to do, beat me up? I'd like to see him try. No, I really would, it would be good exercise for him.)

 

[Guest]

Was notified by doctor today that we only need to do a standard echo at this time and not a stress echo to diagnose my husband's heart murmur.