Part 2 – Testing to Confirm Angina and Select Appropriate Treatment
Test 1 – The Stress Test – Not Much of an Adventure
A week later, I was on a treadmill at the doctor’s offices for my stress test. I frequently used a treadmill—until the angina symptoms began to continue after the New Orleans trip. The test ran for twenty minutes. I was wired to an EKG device. During the test, the medical technician increased the speed and raised the incline on the treadmill. The speed was more than two miles per hour and the incline was at least ten degrees—I suspect more. I maintained this maximum speed and incline for three full minutes. Still, while I did experience some tightness in my chest, I did not get the more intense discomfort that I had experienced in New Orleans.
Following the stress test, the office made an appointment for a heart imaging test. I was in the waiting room at the appointed time.
Test 2 – The Imaging C-Cam – The Adventure Continues
A young man in green scrubs called me back into an examining room. He explained that he was going to give me an injection. The injection was a liquid that would enable the imaging machine to see the details of my heart’s vessels. As I recall, he called injected fluid “magic juice” when I asked exactly what it was. I would have to wait a couple of hours for the “magic juice” to get into my circulatory system, then he would call me back for the actual scan. He suggested I get lunch and be back in two hours.
Shortly after I returned from lunch, I was ushered into the “imaging” room. The main feature in the room is the “C-Cam” (See Figure 1). It is a recliner with a large, square suitcase-sized camera mounted on an articulated arm above the recliner. He positioned me on the recliner, told me to hold still—for 14 minutes—while the images were captured. Once in position, the camera head hovered only millimeters above my chest and moved, ever so slowly, in incremental steps for the 14 minutes, taking images from a series of different angles.
After the test, I did a little research, and determined that the fluid contained a radioactive isotope, and probably one called technetium-99m (Tech-99). The key fact about this “radioactive” isotope is that it produces no more radiation than an X-ray, and that the isotope (since it was floating around in my system), has a half-life of about six hours, meaning that within 24 hours, radiation from the isotope is negligible.
Test 3 – Catherization – The Adventure Becomes More Intense
It was not unexpected. By now, I had spent some hours searching for everything to do with the causes and treatment of angina. Therefore, I was not surprised when Dr. B explained that he wanted to do a catherization. Basically, he would insert a thin tube in my femoral artery in my groin and push it in until it reached the aorta directly above the heart. There, he would inject a contrast agent into the blood that would show the details of the arteries around the heart using an X-ray imaging sysem.
If, as he suspected, it would confirm that an artery on my left ventricle was partially clogged. Depending on the results of the catherization, treatment would be drugs, a stent, or open heart surgery (bypass surgery). He also suggested that, if the stent was indicated, it could be inserted at the same time. He would do the procedure on Wednesday when there would be a specialist on hand to do the stent implant, if indicated. The office set up the appointment time—6:00 am—for the “same day surgery” section, adjacent to the Emergency room, at the local hospital, .
Preparation for the catherization begins in the receiving area of “same day surgery.” I was placed in a small hospital room, and given a hospital gown to put on, with instructions to take off everything but my socks. This included watches, rings, etc. There really was very little waiting. Every step was scheduled and seemed to move along a very deliberate, but efficient pace.
From there I was placed on a highly mobile hospital bed and wheeled to the “Catherization Lab.” It said so on the door. (A momentary image from the Rocky Horror Show flashed through my mind: “…come up to the lab and see what’s on the slab!”)
The lab had a prep area and the imaging area. Catherization (Figure 2) is done in a hospital “clean” room rather than a sterile operating room. Preparation was simple. I was hooked intravenously to a bag of saline, and given an injection to relax me. It was not intended for me to go to sleep, but just avoid being tense. The next step was to shave the insertion site for the catheter. Where is that? Sit upright in a chair. Place you fingers at the point where your thigh folds up against your abdomen. Right there. The area had to be shaved and sterilized, and the nurse explained that she would shave both sides just in case the doctor had difficulty with the first side. But first, she discretely draped a towel from my navel down between my legs to “preserve my modesty,” like at that moment that was my main concern!
Shaved and sterilized, they wheeled me over to the actual catherization area. There a nurse gave me shot of local anesthesia where the doctor would make the incision. There was a curtain obstructing any view of the doctor’s activities, nor could I see any of the imaging equipment being used. I could hear quiet voices, but not much else.
Catherization involves an operating table under a smaller imaging head, while a contrast dye, visible in X-rays, is injected through the catheter. X-ray images show the dye as it flows through the heart arteries. This shows where arteries are blocked. The contrast agent is delivered by the tube inserted in an artery in the groin area—in the same manner that a stint might be implanted.
I was awake for the entire procedure—and felt no discomfort. After about 10 minutes, my doctor, who had inserted the catheter came to the head of the “bed” and said. “The blockage in your heart is too long for a stint. See me next week about ‘EECP’.” That also let me know that he had ruled out any kind of open-heart surgery.
Tomorrow: Part 3 – An Unfamiliar Treatment