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Can Nuclear Stress Tests Miss Severe Coronary Artery Disease?

Feb 24, 2011

Nuclear stress tests can miss severe coronary artery disease; former president Bill Clinton’s nuclear stress tests were normal, five years running, completely missing the severe coronary artery disease that eventually required quadruple bypass surgery.

Yes, nuclear stress tests can miss severe coronary artery disease. I consulted with cardiologist Dr. Steven Shayani, Medical Director of Outpatient Services for Mount Sinai Hospital and Long Island Heart Associates.

Dr. Shayani explains, “Nuclear stress tests may show normal perfusion even if there are multiple blockages, because this type of imaging modality looks at the relative changes/differences in myocardial perfusion.” (Perfusion means flow of blood through vessels.)

“If there are multiple obstructions in the arteries,” continues Dr. Shayani, “The overall image of the heart may appear to be normal — the obstructions appear to be a normal part of the heart. Therefore, the defects may not be detected. It is when one part of the heart is normal and another part is obstructed that the images will allow the clinician to clearly see a defect.”

Nuclear stress tests measure perfusion (flow of blood through the heart) while the heart is at rest, and while it is stressed. A commonly known form of nuclear stress test involves walking on a treadmill. While the patient walks, images of his heart are studied to see if impaired perfusion is detected (a contrast dye is used to make the blood vessels more visible). Sometimes a stationary bike is used.

A nuclear stress test may also be done with a pharmaceutical agent that taxes the heart. Images of the heart are taken while at rest, and under stress.

In the case of former president Bill Clinton, his exams indicated a normal heart, but ultimately, his nuclear stress tests missed what turned out to be severe coronary artery disease. This is truly scary, because one would think that of all people, a former U.S. president would have the best health care! This should include preventive, not just mitigating.

Though the former president’s quadruple bypass was a success (Sept. 2004), this in no way downplays the failure of his medical team for relying upon only nuclear stress tests, which proved to miss significant disease in the coronary arteries.

Does this mean that for coronary heart disease screening, you should skip the nuclear stress tests and jump right into a CT calcium score test or CT angiogram ? It is best to discuss options, including blood tests , with your cardiologist. He will need accurate information about your lifestyle habits and family history of heart disease.

Though nuclear stress tests can, indeed, reveal coronary artery disease, these kinds of exams can miss severe coronary artery disease; after all, look what happened with a former U.S. president.

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