Failed 64 Slice CT SCan..Heart Rate Too High

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harleygirl528

harleygirl528

Well-known member
Joined
Oct 24, 2007
Messages
225
Location
Silverdale, Washington
Hello All,

As many of you know, I am scheduled for surgery Jan 16 with Dr. Sharo Raissi at Cedars Sanai in Los Angeles for aortic aneurysm and bicuspid aortic valve. Dr. Raissi requested that I have a 64 slice CT scan to get a better look at my arteries, etc. so had the 64 slice CT scan today...well that is I was "supposed" to have it but was not successful :( Unfortunately, they could not get my heart rate low enough to perform the test, even with a 50 mg Metprolol this morning and 3 IV injections of Metoprolol, which is the maximum they can administer. So, I went through the whole ordeal for nothing. I have a call in to my surgeon to let him know what happened so I think at this point I will probably just have to wait until I get to California and do the scan there under controlled environment where they can perhaps give me additional medication. Part of the problem was anxiety...the technician did not render a lot of confidence in me as during a conversation prior to the scan he indicated that we would be getting a good view of the "mitral" valve. When I indicated that it was my "aortic" valve we were concerned about he said "Well, they are the same thing." So, needless to say, I didn't feel overly confident with him and his knowledge of the anatomy of the heart. Anyway, it was out of my control as I tried my hardest to relax and even with the maximum doses of beta blocker my heart rate wouldn't go down enough...and my bp was extremely high during the test, even after all the meds! I was glad to get home, relax and even took an extra dose of Cozaar as my bp would not go below 120 (desired reading for now is 105 or lower).

So, just wondering if anyone else had this happen where they couldn't get your HR low enough (tech said had to be below 65 bpm). I am assuming that Dr. Raissi and Cedars Sanai will have a better handle on dealing with this and perhaps additional medications that can achieve a lower HR. Also, with the aneurysm, I was getting worried about the apparent inexperience of the technician and the fact that there was no physician present while performing the cardiac gating.

So, although I am trying to keep my spirits up...I have been getting really stressed lately. Almost feels like when I had my babies and started to "nest"...feaking about getting the house totally clean and organized and getting ready for the big day. My poor husband...I have been a raving lunatic lately...

Anyway, thanks for the continued well wishes. Going to relax and watch a movie or something. Stressful day....

Take care all!!
 
ditto

ditto

Harley - just wanted to chime in and also extend a "sorry to hear about this." You know I'm a newbie so no good technical info to share with you. I bet you get some good responses. Remember, you got a squad of VR.com guys down south from you on I-5 cheering/hoping/praying for you.

You're on the right track... there's a lot to be said for movie-watching therapy! Sounds like you earned it today.

SSS
 
If you Google "64 slice CT scan" you'll see that the 64 slice CT is a relatively new non-invasive procedure that could possibly be an alternative for the tried and true Cardiac Catheterization, which is an invasive procedure. From what I read of the 64 slice CT, they should be able to time the CT to your heart beat, and your heart rate should be lowered for the procedure. I could not find what the threshold was, but 65 bpm sounds pretty low to me. I don't think the majority of folks in the general population could get that low, even with beta blockers. The "normal" human heart rate is 72 bpm. Generally speaking, endurance athletes have lower heart rates due to conditioning, and a very fit athlete like a marathoner or long distance cyclist could have a resting heart rate in the 40's or even lower. I think you're being too hard on yourself by saying you "failed" the 64 slice. You didn't fail anything. You can still do a Cardiac Catheterization and get the same information. Or still take the 64 slice. I wouldn't worry about it. There are lots and lots of folks that could never even come close to 65 bpm. Good luck!:)
 
Hi ....I'm also sorry to hear they couldn't get your test done...
I bet your doctor will get this test done or another one to see what he needs to see before your surgery....
Hope this gets worked out very soon for you....
 
I am pretty sure that my son's heart rate never gets that low, in fact his pacemaker is set for a minimum HR of 70. I think you just got a bad tech. I'm sure they will be able to get one at Cedars Sainai. Sorry you had to go through all that anxiety for nothing.
 
Hey Guys,

Thanks for the reassurance. I did speak personally with Dr. Raissi and he said not to worry about it. He said that a more experienced technician and radiologist would have know that someone my age can and should be given high doses of beta blockers to get the heart rate to that optimum rate. He said that younger people tend to produce high doses of adrenalin in stressful situations so they need higher doses of betablockers to get hr lower. And, younger people (funny, until this heart issue I never felt like a "younger" person) can tolerate a lot more beta blocker without having issues. I think part of the reason that those of us with aortic aneurysms have to avoid cardiac catheterization is that some of us have connective tissue disorders so the tissues are delicate and catheterizations can be too invasive.

At any rate, I guess since the test is fairly new the technicians aren't as well versed as they should be in proper protocol so.....I guess I'll give it another try when I get to California.

As a footnote, my surgeon called me himself and spoke with me in some detail about the above issue and other questions that I had...I was very impressed. He also gave me his cell phone number and said to call him when I arrive in town on Sunday before my surgery. How many top-notch, surgeons of his caliber ever take the time to call a patient personally baout anything and give out their personal cell phone number? Anyway, needless to say I am very pleased!
 
Valve Confusion

Valve Confusion

Hi Harley,

Isn't a valve a valve????

Don't let your experience with an inexperienced tech guy stress you out too much. Things will probably go much better when you get to a better medical facility.

-Philip
 
Glad you are feeling better after speaking to your surgeon, sounds like a great guy. Best of luck with everything, take care
 
Lorie,
Sounds familiar -- My wife had the CT scan about 6 months ago, and they had to wait an extra half hour or so for her heart rate to drop far enough to do the scan. I remember joking that their target of 65 bpm would be no problem for me, as typically when I go for an echo my heart rate drops down to around 50 or so while I'm just laying there. Techs usually ask to be sure I'm awake. . .
 
OMG, Lorie. What a let down! And I'd probably be somewhat fuming about that tech!! :mad: But that's just me! After normal echos pre-surgery, I used to try to pry as much information as I could out of the tech. Most of them would not talk, but this one young guy was great about talking so I felt a good rapport with him. BUT! The last time I had him (and my surgery was still not imminent) I asked him how my heart looked. His quip.... pretty good if you were a 75 year old!!! That really threw me for a few days!!

Sounds like you were experiencing White Coat Syndrome! ;) That's when your nerves give you an unusually high bp, etc.. just because you are in a doctor's office or hospital setting. Don't worry. It just sounds like ALL the arrows are pointing you out of the Seattle area and down to California. So be it. Don't give it another thought. Easy to say, I know.

So there's not much left for you to do this week but sit back and enjoy the holidays with your family. So get some anti-anxiety meds if you need them (or if your family thinks you need them :p ) and shrug it all off and drink in the holidays.

Best wishes!

Marguerite
 
I have had quite a few of those 64slice CT scans and know exactly what you are talking about...My first time was the one that stands out in my mind...I was very anxious and after 4 hours and heaps of Metoprolol (like you) they still werent really happy with my heart-rate...eventually it was sitting around 70-75bpm so they decided to try the scan...it worked just fine...

The scan only takes about 3-5 minutes and half of that is just a test-run to line the machine up...then they do the real run with the dye and its all finished in seconds. If you have had a scan in one of those big donut shaped machines before it is practically the same.

Nowadays I am no-longer anxious about having that test and have no trouble with my heart-rate. What previously took 4-5 hours now takes about 20 minutes all up. Its really no more scary than a regular X-ray so try not to be too anxious.
 
Lorie,

You wrote: I think part of the reason that those of us with aortic aneurysms have to avoid cardiac catheterization is that some of us have connective tissue disorders so the tissues are delicate and catheterizations can be too invasive.

Just wondering where you got the above information and if you can elaborate.

Thanks, Betsy
 
Hi Betsy,

Actually, that was information that was given to me by my surgeon Dr. Sharo Raissi at Cedars Sanai Hospital in Los Angeles. He is an aortic specialist and actually trained with Dr. Griepp in New York, and has a particular interest in connective tissue disorders/bicuspid valve disease. Here is what he says of doing catheterizations on people with aortic aneurysms "Any manipulation with guided wires and catheters in an aorta that is barely holding on with a very thin layer is dangerous because all you have to do is make a hole
in that thin outer layer and the patient will almost certainly die."

That is where I gleaned that information from and as I am trusting him with my life I do agree with his viewpoint on this. Since you now have a surgically corrected aorta you probably won't have any worries with future catheterizations.

By the way, how are you feeling Betsy? I am just around the corner for surgery and hoping to join you all "on the other side of the mountain" very soon.

Take care and happy holidays!
 
I'm kind of surprised that if they can't lower your HR and/or BP to the desired level and suspect anxiety as the cause they didn't give you a "squirt" of Versed into your IV line. If anxiety was causing the high HR the Versed would have knocked it down within a minute or two.

When you get to CA if you might want to ask your surgeon if Versed is an option in conjunction with the Metaprolol to acheive the desired HR if you feel that anxiety is part of the issue. Most of my "white coat syndrome" has disappeared after the endocarditis, surgery, and wire removal with one exception...having my BP taken. I know it's irrational but the fear goes back to a time when I went to the ER (while at work in the hospital I worked at) for a bad case of the flu and when they took my BP it was sky high. They slapped a monitor on me and were kind of freaking out which obviously freaked me out too. I told them it was "WCS"...and after a small dose of Valium and Vistaril my BP and HR were back to normal.
 
Thanks Bryan...good advice. I am sure there are several things that could have been done differently in the hands of an experienced technician. I am very disappointed that I had to be exposed to all that radiation and the scan was not completed, not to mention the stress and anxiety involved. I think I got really nervous when the tech didn't even know the difference between the aortic and mitral valves.

Anyway, thanks for the advice and I will be sure and bring that up during my CT scan in California.

As a footnote, I did have the opportunity to speak with another patient of Dr. Raissi's from here in Seattle...she says she was very nervous as well but as soon as the anesthesiologist came back to talk to her prior to surgery and asked her if she was nervous she doesn't remember a thing until they were telling her to breath after taking out the ventilator! So, with that said, I am happy to know that my surgeon and his team take care of us with the jitters....I think that time waiting on the gurney and getting wheeled into the OR are the scariest times and I would rather just not be aware of it!

TAke care Bryan!
 
Thanks, Lorie for elaborating on the catheterization. And I am doing really well with recovery. The trick is finding the balance between feeling well and overdoing it. Yesterday, walked 4 times for 10 min. outdoors and today am totally knackered. Slowly, slowly is my motto now...one day at a time.

Your day will be here before you know it and then you will be on our side of the mountain. In the meantime, enjoy the holidays and your family and find peace within.

Cheers, Betsy
 
Dual Source CT scanner

Dual Source CT scanner

It is true that the single source 64 slice scanner will produce sharp diagnostic images only if the heart rate is slow preferably 64 bpm or less. However there are now dual source scanners (two X-ray tubes at 90 degree angles) that produce sharp pictures independent of heart rate.I bet they have one of these units at Cedars Sinai in LA. No beta-blocker needed before the test.
 
Marty said:
It is true that the single source 64 slice scanner will produce sharp diagnostic images only if the heart rate is slow preferably 64 bpm or less. However there are now dual source scanners (two X-ray tubes at 90 degree angles) that produce sharp pictures independent of heart rate.I bet they have one of these units at Cedars Sinai in LA. No beta-blocker needed before the test.
Click to expand...

Thanks, I was wonderring why they didn't mention anything about heart rates when Justin had his scan, it must of been one of the newer ones.
 
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