I often hear stories of a guy who has a heart attack and come to find out that 95% of a major blood vessel to the heart was clogged.
How is this not picked up earlier during normal exams? Why isn’t it?
Can’t they do radiation shots to see where the blood flows or whatever?
In: Biology
At 45 yrs, felt like I had a few episodes of something in my chest, finally went in to ER one morning.
All checked out fine, but referred for calcium CT.
Scored at 400. Did Stress Echo.
Cardiologist advised a statin, nothing further. Got a second opinion from another well respected hospital system that reviewed my stress echo test. Cardiologist recommended a heart catheter procedure. Stent was needed in a secondary vessel, 100% blockage. Heaviest dose of lipitor was prescribed. I’m 5 -10, 175llb normal dude, don’t smoke, don’t eat terribly, but I hated exercise.
Periodic stress test this past November per protocol. I felt fine. Dr didn’t like my results.
Three stents needed in my 80% blocked LAD.
I didn’t really notice symptoms. Dr was somewhat surprised. Looking back on hiking this past summer, I was the slow poke in the group, had to stop frequently. I should have taken note.
I have no family history of heart disease. I know exercise about six days a week and have lost a little bit of weight. I’ve cut back dramatically on my carnivorous diet. Ah well.
Point of my story is, it’s hard to know. I’m glad I trusted my gut and went to the ER then got the Calcium scan. This led to two opinions and a catheter. Even after going on the heaviest dose of statin, my LAD went from 65% clogged to 80% in eight years.
I’m confident if I blew it off, I would’ve had a major MI would have been dead by now.
With my LAD opened up wide, now I feel like I’m 25 years younger and I’m not taking it for granted. I’ll be exercising and eating right as I have a second chance.
So the CT scan and the stress echo were the two critical diagnostics…and skilled Doctors for which I am grateful and I hope they are paid well! 😉
If you have money you can definitely do that.
But most people don’t have money, and far more than most people have nothing wrong with their arteries in a routine appointment.
This is one of the important reasons to have an annual eye exam. When Optometrists are looking at the back of your eye, we can actually see cholesterol building up in the arteries and refer you for a cardiovascular workup.
We don’t have the personnel or material resources to do that for everyone, among other reasons.
This is an excellent question. We do have different exam types to see if arteries are clogged. Each of these examinations carries radiation and operation related risks. The doctors assess the risks before ordering the exam: if the patient already has symptoms, the risks from not doing the examination (possible death) surpass the risks of doing the exam (radiation, infection, etc).
When we are talking about screening healthy patients, the former might not be true. The risks of doing the exam might be greater than the risk for clogged vessels. For a single person, the risks are low. However, if we look at the population level, we start to see the problems. I.e. regularly screened population will have more radiation induced cancer, etc, related to the screening.
Experts in my country have just decided that coronary CT is not justified for regular screening of blood vessels, even when the patient has a burden from family (relatives with heart disease), since at this stage the treatment would be the same anyways: reduce risk factors such as smoking, cholesterol. If the patient is symptomatic, the situation is different.
Companies like LifeLock, and others provide a service where they do sonograms of your arteries. I get one every year through my union hall.
Other thing to note is that medical resources: physician time, nurse and OR tech staff availability, clinic space and laboratory respected are actually a finite commodity.
It’s a little hard to understand because we really live in a society where, if you want strawberries in the off season, you can still get them, if you want a sports car and you have enough money, you can still get one.
Medical resources really aren’t like that, however.
We have had times where we ran out of morphine,l and normal saline solution because not enough was being produced
During Covid, we ran out of operating room gowns and boots and facemasks and tiny little rubber nasal cannulas
Nurses are already stretched so thin that they have been leaving the field in droves, causing nursing shortages in hospitals
Physicians are so overworked and stretched that “burnout” is actually a real severe thing and finding ways to prevent it is crucial to maintaining the current medical system.
There are not limitless, timeslots in the cardiac Cath Lab to do fluoroscopic contrast studies on anybody and everybody – there are not enough cardiologists, not enough, OR support staff, insurance companies already deny a huge number of medical claims that are absolutely necessary for patients, and non-reimbursed procedures will be passed directly onto other patients when they receive a $40 Tylenol for a headache, to offset the losses encourage by non-reimbursed procedures, and testing for other patients.
Currently, there are not enough physicians, there are not enough nurses, there is not enough staff for operating rooms, and patients (as well as many hospitals) are getting financially squeezed by insurance companies
I’m not saying this is how things should be, I’m just saying how things are.
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