Questions heart patients should ask before getting an MRI scan

~ Carolyn Thomas

by Carolyn Thomas   ❤️   Heart Sisters (on Blue Sky)

Since I was diagnosed with breast cancer in April, I’ve become obsessed with my hospital’s diagnostic imaging procedures – so far, that list includes my mammogram, ultrasound, MRI, CT scan, bone scan, heart scan (MUGA) – and of course (although not a scan) – my all-important Core Biopsy procedure at the Breast Imaging Clinic.  Keeping track of appointment instructions – plus drinking water non-stop to flush stuff like contrast dye out of my kidneys – are now my full-time (unpaid) jobs.  You can read more about my breast cancer experiences so far in these posts. 

Take MRI scans, for example. Last year, the journal Science published: How MRI works  (basically, this scan uses powerful magnetic fields and radio waves to produce extremely detailed images of our insides.

An MRI machine includes a powerful magnet that does not play well with what doctors call “ferromagnetic metals” – so for your own safety during your MRI, remember this: no metal jewelry, no eyeglasses, no hearing aids, nothing made of metal because of potential hazards. When heart disease was the only serious diagnosis I had to think about, I rarely if ever thought about MRI scans. I knew only that the MRI machine does not expose the body to radiation, it’s non-invasive, it is VERY LOUD  – and you cannot have metal things anywhere around you during this test. This list of course makes patients nervous because our doctors have ordered this scan for us, yet we also don’t want to risk spontaneous combustion because of, let’s say, an old tattoo done with metallic inks. 

Some questions to ask are:

Q:  If I have a metal coronary stent implanted, is it safe to have an MRI scan?

A:  There were early concerns that an MRI’s powerful magnetic field could shake a metal stent out of place. But that does not happen. In fact, the FDA has found it’s acceptable to undergo an MRI almost immediately after having received the most commonly used stents (Harvard School of Medicine, 2002)

Q:  If I have an implanted cardiac device (like a pacemaker or ICD), is it safe to have an MRI?

A:  Doug Rachac is my go-to expert on implantable cardiac devices. For 12 years, Doug worked for Medtronic (a huge company that manufactures these cardiac devices) and then one day he became a heart patient with a implanted defibrillator himself . Doug’s fascinating YouTube video about MRI scans for heart patients (8:45 minutes long) is a must-watch video if you’re a patient with an implanted cardiac device who is scheduled for an MRI scan. Doug reassures us, for example, that pacemakers and ICDs are made of titanium, which is a non-ferromagnetic material, so is not affected by the powerful MRI magnet. Talk to your cardiologist, your device tech or the manufacturer of your device if you have specific concerns.

Q:  If I wear a nitro patch to manage chronic angina, is it safe to have an MRI ?

A:  Tell the doctor who ordered your MRI that you are using a transdermal nitroglycerin patch  before having an MRI scan. Skin burns may occur at the site where the patch is worn during this procedure. Ask your doctor if the patch should be removed before having an MRI scan. You might need to put on a new patch after the procedure (Mayo Clinic).

Q: If I have a tattoo (including cosmetic tattooing of eyebrows, eyeliners or lips) is it safe to have an MRI?)

A:  If tattoo ink contains metallic ingredients or impurities (as many older tattoo inks did)  adverse reactions like burn sensations may occur in tattooed skin on exposure to the forceful magnetic fields of an MRI machine. Permanent makeup is described in the medical literature  as carrying a special risk of MRI‐induced complication due to the commonly used iron oxide pigments in this type of ink  (Serup et al, 2023. PubMed)

Q: If I know that the clothes I’m wearing to an MRI appointment do not contain any metals  (belt, snaps, zippers, etc.) why do I still have to change into a hospital gown for this scan?

A: Thermal burns are the most common injury experienced during MRI. Fabric can trap heat and sweat close to the body, and fabric containing metallic fibers can interact with MRI’s radio frequency waves to induce skin burns. A lack of comprehensive labeling when fabrics do contain trace amounts of metals is an important concern.  The single most effective way to reduce the danger of fabric-induced MRI burns is to require all patients to change into approved hospital gowns prior to MRI imaging (Styan et al,  2023. Current Problems in Diagnostic Radiology).

Q:  If I have metal dental fillings or crowns, is it safe to have an MRI?

A:  Several academic sites suggested “ask your dentist” this question, particularly if the fillings or crowns were done many years ago. Crowns made of porcelain, composite resin, or gold pose no risks from MRI. Personally, because I have 11 gold crowns/onlays,  – yes, I’m basically worth more dead than alive!  – I asked my own dentist this question before Thursday’s MRI. His reassuring response:  “Not a problem!”  and here’s why:  in the same way that a refrigerator magnet will only stick to certain kinds of metal, MRI magnets won’t attract every kind either. Magnets attract only ferromagnetic metals such as iron, cobalt, and nickel. Metal fillings (commonly called silver fillings because of their colour) are made of about 50% mercury, plus silver, tin, copper, and other metals. Magnets have no effect on these materials.” (2020, Dental Health Society).

♥

Q:  What has your experience been like with MRI or other scans?

NOTE from CAROLYN:   My blog-turned-book,  A Woman’s Guide to Living with Heart Disease  is based on many of my 900+ blog posts about women’s unique experiences with heart disease.  You can ask for it at your local library or neighbourhood bookshop (please support your favourite independent bookseller) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

Published by Carolyn Thomas

19 thoughts on “Questions heart patients should ask before getting an MRI scan”

  1. (((Carolyn!))) Hugs to you! I ‘m so sorry that you have been diagnosed with breast cancer.

    I know what you are going through. I had surgery for this last August. Had a very small tumor (1.1cm) and they got all the cancer with the lumpectomy. It had spread just a little bit to my lymph nodes so I didn’t need chemo, just 3 weeks (15 sessions) of radiation treatments. Prognosis is great and now I’m on medication and am told I should be fine. I’m very fortunate and grateful, especially thankful that I had a great surgeon and wonderful care team.

    I have had numerous MRIs for my breasts, however. Before the cancer I had a duct in the same breast that was leaking so they monitored it with several MRIs over a couple of years to be sure it didn’t become cancer. I finally had the duct removed in October 2023 (no cancer then and it seems unrelated to the cancer that I ended up with, but I recently found out that what I had can be considered Stage 0 cancer). So the lumpectomy was my second breast surgery and I sure hope I don’t have to do that again!

    We are monitoring now with mammograms and ultrasounds (they found the cancer last summer during the first mammo after the first surgery). Had another one this past Thursday and everything looks great. Very grateful I don’t need any more MRIs — they are incredibly loud, as you said, and very uncomfortable. It seems to go on forever when you are in the midst of one — you lose all sense of time and space, and staying in one position for 20 or so minutes is hard.

    I never had any trouble with metals during the MRIs although I have 2 stents and a permanent dental bridge and numerous fillings. However, I was shocked when they gave me 4 permanent tattoos before starting radiation treatment! They are tiny spots you can’t even see, smaller than a freckle, but the radiation equipment picks them up to focus the machine into just the right position. (It was fun telling my daughter I had 4 tattoos; she has 3.)

    Wishing you all the best, Carolyn. This is not easy to go through. But I have found that there is a wonderful fellowship of breast cancer survivors (just like heart patients) — I think every woman in my church was praying for me at the time because they had all gone through it too. So you are not alone!

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    1. Hello Meghan – sounds like you have had extra-special care from your team, lots of follow-up just in case, and a great surgeon! That’s so important. I’m so impressed with my surgeon (although I haven’t yet taken advantage of her surgical skills until we get the results of last Thursday’s MRI – plus two nuclear medicine scans.

      A couple weeks ago, for example, she phoned me and we talked for one hour and 45 minutes! Who gets that kind of time with a surgeon?!? She carefully outlined next steps, all possible decisions our “team” might come up with, and finished by reassuring me that “we’re going to take very good care of you…” Just what every patient, no matter the diagnosis, needs to hear.

      I too am suddenly aware that I seem to be hearing every week about yet another person I know who has just been diagnosed with breast cancer.

      Take care – stay out of that O.R. 🙂 ❤️

      Thanks for reminding me of the tiny tattoos – it will be fun to remind my kids and grandkids how “hip” I am (as I’ve been telling them for years!)

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  2. Excellent information as always, Carolyn. I have had MRIs several times, but I have never thought about all these worries. In my early 50’s, an MRI showed something in my brain, but later the doctor just dismissed it, that it was probably just a shadow. I can’t remember why I was having an MRI for my brain. I’m 65 now.

    When I was at University, only 19 or 20, I had a pea size lump and the University infirmary doctor said it needed to be removed and biopsied. It was benign, non-cancerous and no other occurrences. I have two small scars.

    I have had skin cancer removed from my face.

    I guess we just go through these things in our lives and wonder how the heck we have lived so long!

    Still dealing with current unknown issues. Ugh!

    Happy Mother’s Day and best wishes on this new journey. ❤️🍎

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    1. Hi Teri – I think you’re right: the more frequently we undergo a test or procedure, the more routine it seems – and not as scary as it might have been the first time. As Bruce Springsteen sings: “Sooner or later, we get used to anything…” One of my blog readers told me about her own breast cancer diagnosis years earlier, but said that by now she can barely remember any of the details – details that were scary and upsetting at the time.

      Happy Mother’s Day to you too and I sure hope those unknown issues reveal themselves soon!
      Take care…❤️

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  3. I have pacemaker wires from 2011. They are no longer used but cannot be removed. Unfortunately they are not MRI compatible, recently confirmed by the manufacturer.

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    1. Oh dear… I wrote here about a similar incident that happened in December 2011 – not in pacemakers specifically, but in Implantable Cardioverter Defibrillators (ICDs) following reports of premature erosion of the insulation around the electrical conductor lead wires in Riata and Riata ST implanted cardiac devices. The FDA ordered an urgent Class 1 recall (the most serious type of recall) of all leads manufactured by St. Jude Medical Inc.

      But then the FDA, St. Jude, and the Heart Rhythm Society all recommended that these defective lead wires should NOT be routinely removed from patients (even if the cables have broken through the eroded insulating coating) “because of risks associated with the surgery required to remove the leads.” The St. Jude Class Action Lawsuit was filed over St. Jude’s defibrillator lead problems on June 18, 2012.

      I was horrified by those recommendations at the time. I hope you have not suffered from your un-removable pacemaker leads.
      Take care. . .❤️

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  4. Hi

    Thanks so much for this summary. I’ve been following you for a couple of years now and always get something out of your thoughtful posts.

    I am on a wait list for an MRI. A few years ago, after a routine mammogram, I was sent for an ultrasound to check a suspicious spot. It was eventually deemed to be not a problem but as part of the procedures, a tiny bit of metal was inserted in that area of my breast so that subsequent mammograms wouldn’t continue to flag it as a problem. I wonder what kind of metal they use? Any idea?

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    1. Hi Maureen – thanks for your message. I think that the tiny bit of metal you mentioned is a Titanium surgical clip (I had one inserted as well after my breast biopsy) – glad that your ‘suspicious spot’ turned out not to be a problem!
      Take care. . . ❤️

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      1. Thanks Carolyn. Good to know. I was probably told when it was inserted, what kind of metal it was but as we all know, pieces of information fly right past when you are under stress in a medical situation.

        Good luck as you continue to deal with your breast cancer diagnosis. I went through it all 29 years ago, chemotherapy, radiation and surgery and am still here to smell the roses. 💐💐

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        1. Hi again – you’re so right! It’s overwhelming to juggle all the details, appointments, scan instructions, etc. I started a notebook so I can make notes about everything – and I have to re-read my notes almost every day just to make sure I’m not forgetting something important…

          Keep smelling those roses!! 🙂 ❤️

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  5. Pingback: Weekly Round-Up /Journeying Beyond Breast Cancer

    1. Thanks for that 10 score, Gloria! All of these brilliant tech advancements are fascinating – in the MRI clinic, it seemed the loud noises, beeps and pounding noise from the machine were more like musical notes! Take care. . .❤️

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  7. …And for those of us who have had open heart surgery: the metal wires holding our sternums together are made of stainless steel or titanium and are MRI safe !

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  8. Carolyn, I’m sorry to hear of your recent diagnosis. Having read many of your articles on your heart issues, I’m sure you will research the hell out of this and be triumphant!

    Thank you for this recent article as my arthritis and heart issues have meant many visits to imaging. My good wishes are being sent your way!

    Andrea Racicot

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    1. Hi Andrea – oddly enough, when I heard the diagnosis (invasive ductal carcinoma) spoken out loud on April 1st, I couldn’t even ask Dr. Google what that meant. I think I was in deep denial. It took a couple of weeks until I became curious enough about some issue to actually look it up. I too live with both heart and arthritis diagnoses (and I was really upset about that arthritis, which tends to affect my average day far more than my cardiac symptoms – which are well-managed with my meds) I hope yours are, too!

      Thanks for sharing your perspective! ❤️

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