A Few Questions About Echocardiograms...

[Lopburi99]

I had a double DES stent put in my LAD artery and an angioplasty in a different one 18 months ago in the states. I am trying to decide whether to return there for a current evaluation or have it done here. The decision is complicated somewhat because if I were to go there I could get other tests done and maybe even get the inevitable [damned] BHP surgery, with everything covered under my Medicare Part C I have keep in effect. (BTW, I've experienced no adverse symptoms to date and have been adhering to my diet/meds/exercise plans).

I called my cardiologist's office yesterday and explained my dilemma. She of course said it would be best if I returned but suggested before facing that decision I had two tests done here in Thailand first - an "Echo/ultrasound" and a "stress test". I assume for the first she means an echocardiogram. Are they separate tests involving separate costs? I would have thought the echocardiogram process included a stress test component?

Seems like a good idea so I've decided to have those tests done here then reconsider. From what I've read on TV, the tests are not particularly expensive even at Bumrungrad - like about 6-7000 baht.

Here is my question: since my results will be faxed to my cardiologist in Michigan for evaluation anyway, is it reasonable to perhaps have the two tests done here in Lopburi's private hospital by the resident cardiologist there? I am more interested in avoiding the awful to/from trips to BKK than cost.

Thanks for your thoughts.

Edited October 9, 2012 by Lopburi99

[Mobi]

They are two separate tests - an echo cardiogram, and a stress test. The echo cardiogram evaluates many components of your heart in a 'resting state' and the stress test monitors your heart under stress.

I cannot give you the technical details but the stress test provides the results on a EKG graph, whereas the 'echo' test provides several pages of computerised results that shows the condition and efficiency of your heart valves, etc.

About 9 months back I was booked to have an echo followed by a stress test, but the stress test was cancelled as the condition of my aortic valve was so bad the stress test may have been catastrophic....

Provided you have confidence in the staff at the local hospital to carry out the tests in a professional manner, I see no reason why you shouldn't have them done there and send a copy of the results to your doc in the USA.

But if you are in any doubt, bite the bullet and go to Bangkok to have them done.

Good luck.

[chiang mai]

Can I just poinmt out that here in 2012 an ECG is fairly routine stuff that most cardiologists in virtually any hospital in Thailand is going to be able to carry out sucessfully, there's no need whatsoever to go all the way to Bangkok for what is a routine test. BTW I also have a stent and my cardiologist in CM is excellent, fact is I'm spoiled for choice when it comes to heart doctors.

[Pormax]

As I qualified Cardiology Technician (a few moons ago I admit) the stress test is usually performed on a treadmill while wired up to an ECG machine. The idea is to get your heart rate up to see if there are any abnormalities when the heart is pushed to a high level. Totally different thing to an Echcardiogram which uses ultrasound to look and record the heart working through the chest wall.

Any hospital with a cardivascular unit could do this.

[Mobi]

As I qualified Cardiology Technician (a few moons ago I admit) the stress test is usually performed on a treadmill while wired up to an ECG machine. The idea is to get your heart rate up to see if there are any abnormalities when the heart is pushed to a high level. Totally different thing to an Echcardiogram which uses ultrasound to look and record the heart working through the chest wall.

Any hospital with a cardivascular unit could do this.

Precisely. It may be that the echo cardiogram might prove beyond a provincial hospital's expertise . But maybe not, the OP will need to enquire.

[Lopburi99]

Thanks for the replies guys, you've confirmed my thoughts. I've seen both (Mobi's and Chiang mai's) of your postings before and I hope you are both doing well. Chiang mai, I've heard only good things about the cardiologists there. My wife has been wanting to take her first plane trip there and if I didn't need to watch my ฿s so closely I'd go there for my tests. One thing for me which just occurred to me - the last two stress tests I had in the U.S. were both abnormal and for each I was taken straight to O.R. for catheter checks. The first one revealed [only] a 30% blockage in my LAD so I've never been clear why I failed that stress test. Didn't think they were that accurate. The failure of my second test and its related cath check (99% closure), about 3 years later, took me in a siren-blasting ambulance to the parent hospital for my emergency double stent. My point being - it is possible yet again I will need immediate treatment after the ECG. Not likely I don't think, but possible. BTW, my Blue Cross insurance actually covers emergency care anywhere in the world. Somebody would need to help me front the bill but it would be reimbursed. That is the reason I selected that company.

Edited October 9, 2012 by Lopburi99

[Sheryl]

As you have a history of ischemic heart disease it would be best to have the stress test done in a hospital with a fully equipped Coronary intensive care unit. The test itself is no problem, it is the possible complications and aftercare you need to worry about.

[chiang mai]

If you do some research at say the Mayo Clinic web site you'll see that the thinmking on stents has moved on since the early days, studies have now confirmed that stenting is no more effective at prolonging life or preventing heart attacks than a regime of blood thinners such as Plavix. It therefore follows that there should be no need whatsoever suddenly discover a need to stent.

Also, ever since I had my stent inserted I've never had a normal stress test result, with a piece of metal tube stuck inside your cardiac artery that should come as no surprise - talk to the cardio's and they'll tell you it's perfectly normal to have an abnormal test once stenting has been done.

[Lopburi99]

If you do some research at say the Mayo Clinic web site you'll see that the thinmking on stents has moved on since the early days, studies have now confirmed that stenting is no more effective at prolonging life or preventing heart attacks than a regime of blood thinners such as Plavix. It therefore follows that there should be no need whatsoever suddenly discover a need to stent.

<snip>.

Now THAT is interesting!

[chiang mai]

If you do some research at say the Mayo Clinic web site you'll see that the thinmking on stents has moved on since the early days, studies have now confirmed that stenting is no more effective at prolonging life or preventing heart attacks than a regime of blood thinners such as Plavix. It therefore follows that there should be no need whatsoever suddenly discover a need to stent.

<snip>.

Now THAT is interesting!

It's worth pointing out that drugs such as plavix alone cannot do anything to alleviate stenosis or the pain from stenosis, in those areas stenting is the prefered way forward, particularly where restenosis occurs. But the like for like studies underataken firstly by the VA hospital and secondly by the Mayo Clinic looked at reducing the risk from partial stenosis (blockages), where there is no pain involved and the stenosis is less than 80%, Plavix is an equally good solution.

Another really good development that has yet to reach the market (I think) is stents that are made from corn flour which disolve after about two years, that looks like a terrific solution.

Finally, whilst rambling, the DES vs non DES debate has come down very firmly on them both being equal, providing non-DES stents are used in conjunction with Plavix or its equivelent, perhaps worth remembering from a cost standpoint when next asked which you might prefer.

[Lopburi99]

If you do some research at say the Mayo Clinic web site you'll see that the thinmking on stents has moved on since the early days, studies have now confirmed that stenting is no more effective at prolonging life or preventing heart attacks than a regime of blood thinners such as Plavix. It therefore follows that there should be no need whatsoever suddenly discover a need to stent.

<snip>.

Now THAT is interesting!

It's worth pointing out that drugs such as plavix alone cannot do anything to alleviate stenosis or the pain from stenosis, in those areas stenting is the prefered way forward, particularly where restenosis occurs. But the like for like studies underataken firstly by the VA hospital and secondly by the Mayo Clinic looked at reducing the risk from partial stenosis (blockages), where there is no pain involved and the stenosis is less than 80%, Plavix is an equally good solution.

Another really good development that has yet to reach the market (I think) is stents that are made from corn flour which disolve after about two years, that looks like a terrific solution.

Finally, whilst rambling, the DES vs non DES debate has come down very firmly on them both being equal, providing non-DES stents are used in conjunction with Plavix or its equivelent, perhaps worth remembering from a cost standpoint when next asked which you might prefer.

My thought regarding what was interesting is as follows: It gives me a high level of hope those of us who religiously adhere to the Plavix regimen as well to 'behave' otherwise may face only a very small chance of further stenosis after receiving our stents. It also gives me higher hope for the other diseased artery upon which I received an angioplasty only (due to being at a branch). Branch blockage present problem issues for stenting but if Plavix [plus aspirin in my case] is so effective against further clotting maybe we who've also had angioplasties have yet additional reason for optimism. [Last I heard a special bifurcation stent is still being tested in Europe -- think of it as a branch stent -- not yet U.S. FDA approved].

Edited October 9, 2012 by Lopburi99

[Mobi]

Sounds like you should follow Sheryl's advice and have your check-up in BKK.

I think it is usually the angiogram that often precipitates emergency surgery. In my case. a few years ago the opposite happened. The stress test indicated I needed a stent, but when they did the angiogram, as a preliminary procedure before inserting the stent, they decided that I didn't need one after all.

A slight digression, but I am now convinced that all my coronary problems through the years were due to a congenital defect in my aortic valve but this wasn't discovered until it got really bad. (They didn't know it was a congenital defect until they removed it), Up until that point cardiologists from all over the world told me my problems were due to coronary stenosis, even though the stress tests were always a bit unconvincing and the angiograms only showed mild stenosis.

Yet My BP was incredibly high and I experienced excessive fatigue, arm and chest pains.... Then one day - 'Oh! You need to get your valve replaced or you won't be long for this world....'