If there were EKG changes during the stress test and he has moderate risk factors, then I would expect the next step to be a nuclear stress test to test for ischemia. To go straight to the cath lab with the same Dr who ordered the stress test is a concern. I too would recommend a second opinion from a second cardiologist.

Stress ECG's are reasonable screening tools for evaluting symptoms suggestive of advanced, obstructive coronary artery disease such as angina or unexplained shortness of breath in individuals at intermediate risk of disease (Baye's theorem). They are virtually worthless and potentially harmful in low risk individuals (false positive far more likely than true positive). They can be just as useless in very high risk populations (high pre-test probability of disease) because of the risk of false negatives. Stress tests as predictors of future coronary events (MI) in unselected patients are virtually worthless because the majority of MI's are due to disruption of inflamed, non-obstructive atherosclerotic narrowings that are completely undetectable by this modality. In fact, we currently do not have practical tools to detect these "vulnerable plaques" at all.

Steve, Moses, thanks for all this info. I wish I would have posted this two weeks ago.:mad:

You wouldn't benefit from a visit to Moses unless you're preggars :D

I find this infuriating. They put you at very real risk for no reason. Cardiac caths are not simple tests. They are invasive and things can go wrong. Terribly wrong. I'm glad you're OK.

Unethical doctors scare me far more than incompetent ones. I wonder how many unnecessary caths your cardiologist performs every year. How many of those go on to get unnecessary bypass surgery?

It's a little much too not allow a CV doc to stress test and cath. That is more dangerous in my mind as a patient would get treated as a test result rather than in a context of his/her symptoms lifestyle etc.

The best way to find a good doc is to ask hospital (in this case cath lab or noninvasive testing) staff who they/families go see and why. The original stress test reasoning is suspect given the details provided here.

We know some things about vulnerable plaque and while not directly testable (per lesion), can give fairly good assessments of overall risk of events.

I agree Art, the point that I didn't convey clearly is that I would have preferred a second opinion from a different doc other than the one who ordered the stress test. I understand that it is standard practice for the cardiologist to perform both the stress test and cath.

I don't know that you need a second opinion in this case. Not to pile on, but there is no medical literature to support screening stress tests. A 44 year old man without comorbidities should not have a stress test performed (much less a cath...holy crap!) unless there are concerning symptoms present. Heck, depending on what your cholesterol panel looks like, you probably don't even need statins at this point...

Weird story.