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Forum Name: Cardiology Diagnostics

Question: Shellfish alergy preclude an angiogram?


 monkey - Mon Mar 21, 2005 8:36 pm

My husband's father and oldest brother both had heart-attacks before the age of 40. His next oldest brother (my husband is 36, the youngest of six children) has been diagnosed with angina.
Yesterday my husband experienced chest pain and pressure with fatigue and dizzyness. Took him to the emergency room and he was admitted to the hospital overnight for observation. EKG's were normal; blood tests throughout the evening showed that his enzymes were also normal.
The cardiologist wanted my husband to have an angiogram, but my husband is alergic to shellfish. We've been told that he can't have the test, or that if he did it would be extremely risky. Surely there is a synthetic alternative to the squid-ink derived dyes used in an angiogram? Surely there must be many, many people with seafood alergies.
 Dr. Yasser Mokhtar - Tue Mar 22, 2005 12:02 pm

User avatar Dear Monkey,

Patients who are allegic to shellfish do have an increased propensity to reaction caused by the dye but it is no greater than patients who are allergic to peanuts, eggs, or strawberries.

There are medications that can be given within the previous 12-24 hours period to patients with food allergies such as shellfish or allergy to the dye itself. These medications will recude the incidence of such allergic reactions but it does not reduce the risk to zero. These are steroids and antihistamines.

The risk has to be weighed against the benefit and then a decision made, whether or not go ahead and perform the angiogram.

If your cardiologist does not feel comfortable performing this, most probably he thinks that the risks of performing the angiogram with your husband's history of chest pain and that of allergy, outweighs the benefits.

Your husband is a male who has a very strong positive family history of coronary disease and these are two major risk factors for coronary disease, nothing else was mentioned about other major risk factors for coronary disease he might have such as high blood pressure, diabetes, smoking and high cholesterol. Does he exercise on regular basis? You also did not mention the charateristics of the chest pain your husband had when he was admitted to the hospital.

An angiogram sounds a very reasonable next step with your husband's family history.

There are other dyes that are not iodine based and there are other alternatives to an angiogram such as magnetic resonance imaging (mra) of the coronaries and heart but these are not as good as angiography with an idonine based dye.

A second opinion is always another option.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 monkey - Tue Mar 22, 2005 8:17 pm

Thank you so much for your swift and informative reply!
My husband is now a non-smoker (quit smoking 13 months ago). Although he is active - he walks 8-10 miles a week - he is admittedly overweight at 72" tall, 265 lbs. We just learned that he does have high cholesterol and are taking steps to radically change both our diets to reduce fat and cholesterol and add more fiber.
He described the sensation in his chest and neck as "pressure" and "squeeze" rather than sharp pain. He was a little short of breath. He did not get sweaty, though he was warm to the touch and nauseous.
His blood pressure has always been fine, even on the low side, though not abnormally so.
His mother and paternal grandmother both had diabetes.
He is scheduled for a stress-test this week and we hope to learn more.
Once again, thanks so much for your response. Would welcome any additional information you may have to share.
 Dr. Yasser Mokhtar - Wed Mar 23, 2005 9:29 am

User avatar Dear Monkey,

Thank you very much for the update.

Your husband has 2 additional major risk factors which are high cholesterol and smoking (even though he stopped a year ago, the effect of smoking on the risk of developing a heart attack goes down to 50% by 1 year and goes away completely after 15 years).

At his age without his risk factors, most probably, he wouldn't have gotten even a stress test. A stress test is not an unreasonable choice, but i personally think that your husband's case warrants an angiogram like it was first thought but with his history of allergy, let's wait and see what the stress test will show.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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