Should I Undergo Cardiac Catheterization for Arrhythmia Symptoms?

Is it advisable to perform a cardiac catheterization for arrhythmia suspected to be caused by angina?

Hello Doctor: I am a patient with antiphospholipid syndrome.
I was diagnosed with optic nerve disc narrowing in April last year, and in August, I experienced central retinal vein occlusion (CRVO) and multiple neuropathies.
In the past couple of months, I have frequently experienced palpitations, occasional dizziness, chest tightness, and a constricting sensation in the left side of my chest.
Routine EKG, echocardiogram, 24-hour EKG monitoring, and exercise EKG all showed ventricular premature contractions (VPCs), with approximately 3000 occurrences per day, including couplets, triplets, quadriplets, and paired VPCs.
During the exercise EKG, the doctor noted that several values decreased during exertion, indicating hypoxia and suggesting cardiovascular disease.
I was advised to undergo a CT scan or cardiac catheterization at my own expense, but the doctor mentioned that the accuracy of the CT scan is only about 70%.
I would like to ask the doctor if a cardiac catheterization is necessary for my condition.
I remember not having VPC issues in the past, but they have become quite frequent recently, and I have experienced several episodes of sudden dizziness and chest tightness, feeling so faint that I wanted to vomit and couldn't stand.
Currently, the doctor has prescribed me antiarrhythmic medication, digoxin, and sublingual NTG to keep on hand.
I have been taking Beraprost regularly for four years.
The doctor mentioned that at my age, with no hyperlipidemia, weighing 48 kg, no hypertension, and having taken Beraprost regularly for four years, it seems unusual to develop angina.
Today, I experienced two episodes of palpitations, chest tightness, and dizziness, which completely resolved half an hour after taking my medication.
I would like to know if this can be considered as symptoms of angina.
Since I am not yet 35 years old, if I were to develop angina now, would the likelihood of recurrence be higher in the future? Thank you, Doctor, for your patience in reading this.

Yvette Wu, 30~39 year old female. Ask Date: 2020/04/04

Dr. Wu Xueming reply Cardiology

"Ventricular premature contractions" (VPCs) are irregular heartbeats that occur when the ventricles contract on their own before receiving signals from the normal cardiac conduction system, representing a type of arrhythmia.
If an echocardiogram shows normal cardiac function and a 24-hour Holter monitor does not reveal any other malignant arrhythmias, VPCs are generally considered benign.
Prevention can be achieved through lifestyle modifications, maintaining emotional stability, managing stress, avoiding smoking, and limiting the intake of alcoholic and caffeinated beverages.
If symptoms persist, a visit to a cardiology clinic for pharmacological treatment may be warranted to reduce the frequency of episodes.

Chest pain can be categorized as either cardiac or non-cardiac.
Cardiac chest pain, commonly referred to as angina, typically has the following characteristics: 1.
It lasts for several minutes (2-10 minutes), is described as pressure-like, and may cause shortness of breath (like an elephant sitting on the chest).
2.
It may radiate to the jaw or left arm.
3.
It is usually triggered by physical activity or emotional stress and improves with rest.
4.
It is more prevalent in patients with risk factors for coronary artery disease, such as: age (men >45 years or women >55 years or postmenopausal), hypertension, hyperlipidemia, diabetes, smoking, family history of early coronary artery disease, sedentary lifestyle, and low physical activity.
Based on your symptom description, if an exercise stress test shows abnormalities, a CT scan or cardiac catheterization can help determine if there is significant narrowing or blockage of the coronary arteries.

Reply Date: 2020/04/04

More Info

Based on the information provided, it appears that you are experiencing a range of concerning cardiovascular symptoms, including palpitations, occasional dizziness, chest tightness, and episodes of chest discomfort. Given your medical history, including the presence of ventricular premature contractions (VPCs) and the findings from your exercise electrocardiogram (ECG), it is understandable that you are considering whether cardiac catheterization is necessary.

Understanding Your Symptoms and Risks:
Your symptoms of palpitations and chest discomfort, particularly when associated with exertion or stress, can be indicative of underlying cardiac issues. The presence of VPCs, especially in significant numbers (3000 per day), raises the concern for potential structural heart disease or ischemia. The fact that you have experienced episodes of dizziness and chest tightness, which resolve after taking your prescribed medications, suggests that these symptoms may be related to transient ischemic events or arrhythmias.

Cardiac Catheterization Considerations:
Cardiac catheterization is a procedure that allows direct visualization of the coronary arteries and can help determine if there are blockages or significant narrowing that could be contributing to your symptoms. Given your history of visual disturbances and neurological issues, it is crucial to rule out any cardiovascular causes that may be exacerbating your condition.

1. Risk Assessment: Your age and lack of traditional risk factors (such as hypertension and hyperlipidemia) do make it less likely that you would have significant coronary artery disease (CAD). However, the presence of symptoms and the findings from your stress tests suggest that further investigation is warranted.

2. Diagnostic Accuracy: While you mentioned that the CT scan has a 70% accuracy rate, it can still provide valuable information about the anatomy of your coronary arteries. Cardiac catheterization, on the other hand, is considered the gold standard for diagnosing CAD and can provide a more definitive assessment.

3. Symptom Management: The medications you are currently taking, including antiarrhythmics and nitroglycerin, are appropriate for managing your symptoms. However, if your symptoms persist or worsen, it is essential to communicate this to your healthcare provider.

4. Future Considerations: If you are diagnosed with CAD or significant ischemia, it is important to understand the implications for your long-term health. While younger patients can experience coronary artery disease, the risk of recurrence or progression can depend on various factors, including lifestyle, genetic predisposition, and management of other health conditions.

Conclusion and Recommendations:
Given your symptoms, the frequency of VPCs, and the findings from your previous tests, it would be prudent to discuss the option of cardiac catheterization with your cardiologist. This procedure could provide clarity regarding the state of your coronary arteries and help guide further treatment. Additionally, if you experience any new or worsening symptoms, such as increased chest pain, shortness of breath, or significant dizziness, seek medical attention promptly.

In summary, while your age and lack of traditional risk factors may suggest a lower likelihood of CAD, the presence of symptoms and abnormal findings necessitate further evaluation. Cardiac catheterization could be a valuable tool in determining the underlying cause of your symptoms and ensuring appropriate management. Always keep an open line of communication with your healthcare provider regarding your concerns and symptoms.

Similar Q&A

Assessing the Necessity of Cardiac Catheterization: Risks and Benefits

Hello, I have been experiencing shortness of breath during exercise and occasional chest tightness. I have undergone an electrocardiogram (ECG) and a 3D echocardiogram, both of which were normal. However, the exercise ECG showed mild hypoxia. A myocardial perfusion scan revealed ...

Dr. Lin Jixiong reply Cardiology
Hello: Undergoing cardiac catheterization carries certain risks. If you frequently experience symptoms such as chest tightness or chest pain, and the frequency of these episodes has increased, you may consider having a cardiac catheterization. However, if you are currently on med...

Understanding Cardiac Catheterization: Is It Necessary for Your Health?

Hello Dr. Huang, I previously inquired with another physician about my family member's symptoms of rapid breathing and a sensation of being pricked. My family member is 55 years old and has not yet reached menopause. The physician I consulted earlier indicated that it is n...

Dr. Huang Yinghe reply Cardiology
Hello: Based on your description, a 55-year-old female with a history of secondhand smoke exposure and no hypertension. If there is no history of diabetes or high cholesterol, and no family history of cardiovascular disease, the likelihood of coronary artery disease is indeed low...

Should You Undergo Cardiac Catheterization After 24-Hour ECG?

Hello, Doctor. I recently completed a 24-hour Holter monitor, and the cardiologist suggested a cardiac catheterization due to my slow heart rate to assess my heart condition. I have a habit of jogging and have had sinus bradycardia since childhood. The examination report is as fo...

Dr. Wu Xueming reply Cardiology
According to your report, there is a phenomenon of bradycardia. It is recommended to visit an outpatient clinic for a physician's evaluation to determine if a pacemaker is necessary.

Understanding Cardiac Catheterization: Purpose, Risks, and What to Expect

Hello Dr. Lee: I went for a check-up for heart disease, and in addition to an electrocardiogram and cardiac imaging, the doctor is now requesting that I be hospitalized for a cardiac catheterization. What is cardiac catheterization? Why is this test necessary, and why do I need t...

Dr. Li Huixiong reply Internal Medicine
In simple terms, cardiac catheterization or cardiac catheter therapy refers to the procedure of inserting a thin tube through the skin and into the blood vessels to reach the heart for further examination, evaluation, or treatment. From your description, it is understood that you...