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Date of last update: 10/20/2017.

Forum Name: Ischemic Heart Disease

Question: Can stress testing be seriously wrong?

 Amma_Leigh - Wed Apr 27, 2005 2:10 pm

I am a 25 yr old female who understabds that women of this age are protected from coronary disease.
My real question is, can stress testing be seriously wrong?
Can there be a negative result where there is very serious disease.
Also is fatigue a huge indicator for heart disease when combined with pain in left arm and palpitaions and a general feeling of being unwell?
Thanks for your help.
 Dr. Yasser Mokhtar - Tue May 03, 2005 11:21 pm

User avatar Dear Amma,

To decide whether or not chest pain is caused by coronary disease, two things are assessed, major risk factors that the patient (suffering from chest pain) has for coronary disease and the characteristics of the chest pain (as compared to those caused by chest pain of coronary origin), the probability of this pain be due to coronary disease is then determined.

If the patient has had many risk factors and the pain is typical coronary pain, the probability is high, if the patient does not have any risk factors and the pain is atypical, the probability is very low. And there are other probablities in between.

This same probability is used to predict the results of stress tests as well. Meaning that if the probability that this pain be due to coronary disease is very low or low, then the probability that the stress test is going to be positive is also very low or low.

Stress tests are not perfect, otherwise, other procedures to diagnose coronary disease wouldn't have been developed.

About your question about fatigue, these symptoms can not just be taken out of the whole picture and the question answered, it has to be put into the clinical context and answered. Reason being, that fatigue is a very non-specific symptom of heart disease and many other diseases.

In your case, you did not mention any major coronary risk factors (besides drinking) and the characteristics of your chest pain sound atypical, so the probability (irrespective of you being a female of the child bearing age) of this pain be due to coronary disease is very low. On top, as i understand that you had a negative stress test.

There is one heart cause of chest pain called mitral valve prolapse which is diagnosed by echocardiogram (ultrasound of the heart) and just needs to be followed.

i recommend that you have an echocardiogram if you have not had one yet to exclude this condition which is a cause of chest pain and palpitations in otherwise healthy young individuals.

Other causes of chest pain include reflux disease, neck problems, local chest causes such as inflammation of the cartilages of the risbs of the chest and anxiety.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.

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