Eddy Edson
Well-Known Member
- Relationship to Diabetes
- In remission from Type 2
At the end of 2023 an angiogram made it clear that I *didn't* need a triple bypass (phew!) despite a prior CT scan radiologists' convictions that my coronary arteries were just about completely blocked.
This illustrated to me just how subjective non-invasive imaging studies like CT scans can be. The error was surely due at least in part to my cardiologist pretending I had chest pain and shortness of breath to slip me through triage, and the radiologists happily indulging in a spot of confirmation bias. If they'd known that I was in fact symptom free & that my stress echo was negative, I expect their conclusions might have been different.
Anyway, a few months ago I had a follow up with my cardiologist. Back on the treadmill for a repeat stress echo, still symptom-free but this time he thinks there were signs of ischaemic LAD disease - ie a big narrowing in the main heart artery, the thing which causes "widow makers".
I'm dubious - still no symptoms despite well above-average effort for my age on the stress echo, all of my risk factors (BP, BG, lipids, inflammation) optimal, very active, very low prior probability of any CAD progression. Stress echo false positives are a thing, and it's another non-invasive study with a big element of subjectivity.
Nevertheless I have to take it seriously, so a couple of weeks ago I had another angiogram.
The first time, at the end of 2023, the procedure had been a 10 minute painless nothing-burger, with the biggest hassle having to wait in the cath lab afterwards for a few hours for the entry wound in my wrist to heal, flopping around with all the other 60-somethings.
This time I was on the table for 90 minutes, pumped so full of fentanyl and other c**p that I had to vomit, nevertheless in quite a lot of pain as the intervetionist tried and failed to get a catheter into my heart via my right wrist, right groin and left wrist, in turn.
There were reasonably plausible-sounding explanations for the wrist failures but I'm pretty sure the groin attempt was just inept. It targets the common femoral artery as a route up into the heart. They use bedside ultrasound to guide the catheter placement and its journey upstream. The interventionist claimed that ultrasound showed that my right CFA was "80% blocked", too much for him to safely work with.
This was actually absurd, for a bunch of reasons, for anybody who knows about peripheral arteries & my history (ie walking 18k steps per day with no claudication symptoms in that leg; a CT scan from 2021 which showed less than 20% CFA stenosis etc etc). I know a tiny bit about ultrasound and on reflection it seems clear that he was defeated by calcified plaque in the artery, which can look like major stenosis if you don't know what you're doing.
Anyway, the outcome of this fiasco was a decision to get an updated CT scan of my lower arteries to check out what's what. I've just had this, and unsurprisingly it shows no change since the 2021 scan. So the idea is to re-try the angiogram - with the same intervention team, but hopefully more clued-up this time around and with a vascular specialist on hand if more clue is needed.
Most of the people involved in this have been good folks, eager to help, consulting colleagues all across town, trying really hard. I just wonder though how competent they are, and how I would assess the competence of alternatives if I wanted to make a change. Patient feedback via Google reviews or whatever isn't very useful IMO - it mainly reflects how people experience the specialist's manner. As far as I know, there isn't any kind of accessible professional competence assessment record except for records of major issues which is not what I'm thinking of here.
Mistakes were made, but that's human; there is no sign of gross negligence or anything like that; why would any alternative team be likely to make fewer mistakes; maybe the current team will try harder than a new team in an effort to rectify things. And so on. In the end I'll no doubt stick with these guys ....
This illustrated to me just how subjective non-invasive imaging studies like CT scans can be. The error was surely due at least in part to my cardiologist pretending I had chest pain and shortness of breath to slip me through triage, and the radiologists happily indulging in a spot of confirmation bias. If they'd known that I was in fact symptom free & that my stress echo was negative, I expect their conclusions might have been different.
Anyway, a few months ago I had a follow up with my cardiologist. Back on the treadmill for a repeat stress echo, still symptom-free but this time he thinks there were signs of ischaemic LAD disease - ie a big narrowing in the main heart artery, the thing which causes "widow makers".
I'm dubious - still no symptoms despite well above-average effort for my age on the stress echo, all of my risk factors (BP, BG, lipids, inflammation) optimal, very active, very low prior probability of any CAD progression. Stress echo false positives are a thing, and it's another non-invasive study with a big element of subjectivity.
Nevertheless I have to take it seriously, so a couple of weeks ago I had another angiogram.
The first time, at the end of 2023, the procedure had been a 10 minute painless nothing-burger, with the biggest hassle having to wait in the cath lab afterwards for a few hours for the entry wound in my wrist to heal, flopping around with all the other 60-somethings.
This time I was on the table for 90 minutes, pumped so full of fentanyl and other c**p that I had to vomit, nevertheless in quite a lot of pain as the intervetionist tried and failed to get a catheter into my heart via my right wrist, right groin and left wrist, in turn.
There were reasonably plausible-sounding explanations for the wrist failures but I'm pretty sure the groin attempt was just inept. It targets the common femoral artery as a route up into the heart. They use bedside ultrasound to guide the catheter placement and its journey upstream. The interventionist claimed that ultrasound showed that my right CFA was "80% blocked", too much for him to safely work with.
This was actually absurd, for a bunch of reasons, for anybody who knows about peripheral arteries & my history (ie walking 18k steps per day with no claudication symptoms in that leg; a CT scan from 2021 which showed less than 20% CFA stenosis etc etc). I know a tiny bit about ultrasound and on reflection it seems clear that he was defeated by calcified plaque in the artery, which can look like major stenosis if you don't know what you're doing.
Anyway, the outcome of this fiasco was a decision to get an updated CT scan of my lower arteries to check out what's what. I've just had this, and unsurprisingly it shows no change since the 2021 scan. So the idea is to re-try the angiogram - with the same intervention team, but hopefully more clued-up this time around and with a vascular specialist on hand if more clue is needed.
Most of the people involved in this have been good folks, eager to help, consulting colleagues all across town, trying really hard. I just wonder though how competent they are, and how I would assess the competence of alternatives if I wanted to make a change. Patient feedback via Google reviews or whatever isn't very useful IMO - it mainly reflects how people experience the specialist's manner. As far as I know, there isn't any kind of accessible professional competence assessment record except for records of major issues which is not what I'm thinking of here.
Mistakes were made, but that's human; there is no sign of gross negligence or anything like that; why would any alternative team be likely to make fewer mistakes; maybe the current team will try harder than a new team in an effort to rectify things. And so on. In the end I'll no doubt stick with these guys ....
