You need a heart cath!

Often a patient with a suspicion for coronary heart disease will have a non-invasive evaluation like a stress echocardiogram as an initial objective evaluation. If significant abnormalities are present a cardiac catheterization for possible revascularization therapy will be pursued. Obviously it is financially advantageous to have an abnormal non invasive study that will justify a follow up catheterization. The problem is that these stress tests, especially stress echocardiograms are very subjective. There is a cardiologist in my community who will acutally choose images for the final report on a stress echo that are either off axis or poor quality so that he can interpret the study as abnormal and subject the person to further testing even if it actually is a normal study! When the cath comes out normal, he tells the person that it was a good thing that he did the invasive procedure to find out for sure that the coronaries look okay and they are usually very happy to learn that they don't need bypass surgery. (Had he been honest in his interpretation of the stress test, the wouldn't need bypass surgery or the cath that he just did for the money.)