Which heart test is best? Previous heart attacks, unstable angina

[suggestionsplease1]

I'm going to talk to my dad (71, previous heart attacks in early 50's, stents put in and taking regular medication. His dad died of coronary artery disease at the age of 52) about hopefully getting heart tests.

He underplays everything as he doesn't want to worry my Mum, but I'm concerned from what he has been saying recently - feeling tired much more readily, feeling a bit faint, although not actually fainting, discomfort, weariness - heartburn like symptoms after slightly heavier meals.)

Anyway he did visit the hospital over this last year and they did an ECG and a stress test I believe, which showed no major problems. However I'm concerned this wouldn't necessarily establish that there are underlying problems - his heart condition seems to be a bit weird in that it's not reliably triggered by exertion - his heart attacks came during periods of rest for eg.

He doesn't want to bother the NHS at this time, and thinks others need the service more, and I think he feels that he will be embarassed if nothing is shown up. So I don't know that I'll persuade him on this point - but he and my mum are quite well off he and can afford to have private investigations, which I think he could get his head around more.

Does anyone have any advice from experience or expertise about what he should do? I think his GP said an angiogram might be suitable, but that there are slight risks with these as well?

Hi OP.

He needs to understand the sooner he’s seen , the less ‘trouble’ he is for the NHS.

Start with GP. You say he’s on medication... when was it last reviewed?
Could be as simple as that.

If GP recommends more investigation, say with a cardiologist, he has the choice to go private so as ‘not to bother’ the NHS if he wishes.

Good luck

Many thanks @tanstaafl, that's a good point that he might pay attention to if he would cause the NHS more difficulties by delaying on this.

I think his medication has been checked, like I say he was on the radar because of last year, but because the EGC and stress tests appeared ok they haven't advised doing anything else, and I think he's worried that they'll say the same thing again and he doesn't want to make a nuisance of himself.

I'm just worried the brief ECG and stress tests might not have picked up problems, because his condition seems to present weirdly, not reliably under exertion.

If he doesn't want to bother the NHS, it sounds like the best thing for him would be a proper review by a cardiologist. They would be best placed to advise on any further tests. I imagine that would also be fairly straight forward to arrange.

Sounds like maybe his heart valves need checking by echo?

That's interesting that you say that @Clemmieandareallybigbunfight, as his son, my twin bro, has bicsupid aortic valve (discovered by chance on a trip to Everest Base camp by students that were asking for volunteers to test). My dad seems to think this or similar is not an issue for him, as surely they would have identified this after the heart attacks in his 50s. But I had thought this was highly hereditary and with his own father's early death, was quite a plausible source of issues. I think I remember reading that even if they don't have bicuspid valve specifically, close relatives are fairly likely to have other heart problems, stenosis etc.

And I can't seem to persuade my brother to follow up on this bicuspid aortic valve either, as he says he is having no symptoms, but I worry it will be too late if something big happens.

If there is a case of BAV in the family there is a higher incidence of other congenital heart defects in other family members according to my cardiologist.My mother had a valve replacement because of BAV when she was 72, i have a mitral valve prolapse (MVP) and my teen dd has aortic regurgitation and an anomolous right coronary artery (ARCA)
Your brother should be having his BAV checked, think every 2/3 years is suggested.
If your dad has had an ECHO in the past i would have thought a valve issue would have been picked up.

A holter monitor may be a good idea if he is showing signs of dizziness.