Is anyone here a cardiologist, I've got some questions

In My Humble Opinion
1

I’m reasonably young as far as heart disease go, but it runs in my genetic line so I’ve got something of a fatalistic attitude about it. I am wondering what I can do to diagnose the problem as it happens and stay on top of it rather than be caught off guard in my 50s like some people have been.

I’ve had a couple EKGs and they turned out fine. What other diagnostic tests can or should I have done, and at what age? Stress test, angiogram, CT scan, coronary calcium scan, etc? Is there a linear progression (something shows up on an EKG, then get a stress test, if something shows up get a coronary calcium scan etc)?

What about implants that detect heart attacks? Do these detect blockages anywhere, or just in the heart?

Also to my knowledge my genetic line is just heart attacks. I don’t think (not sure but doubt) anyone has had a stroke or blockage to a leg or in the lung. It seems to be mostly heart. But evenso, would a device like the one above detect blockages anywhere? Does the body give off the same biomarkers irrelevant of whether the blockage is in the heart, brain, leg, lung, etc? I think the device above is more of a 24/7 EKG that signals something is wrong. But if you get a blockage somewhere other than the heart, are there universal biomarkers that can be detected via implant to let you know to get medical care?

I was wanting to read Dick Cheney’s book about heart disease because his disease progression mirrors many advances in the field of cardiology.

Does anyone have any predictions for cardiology over the next 20-50 years? I’ve seen studies on injected stem cells into areas of the heart damaged by a MI, possibly showing rejuvination of those areas. Also diagnostic devices like the one I posted earlier so a person knows something is wrong and can get emergency medical treatment.

It is my understanding that VADs are progressing to the point where they are end point devices rather than a bridge to transplant, and some people are living for years with artificial hearts now. So heart failure treatment seems to be advancing. But what about advances in the prevention and detection of blockages, or treatment after the fact?

2

See a cardiologist.

3

OK, what sort of heart disease are you talking about? What are the causative factors, if any can be known?

In my family there is rampant cardiovascular disease but it’s caused by a single gene which you either have or you don’t - and you can be tested for that now. Those of us who don’t have the gene can, if we behave ourselves, probably avoid heart disease entirely. Those of us who have the gene will have heart disease… but medical intervention means instead of having a fatal heart attack in the 40’s those folks can live a normal lifespan.

On the other hand, those without the gene can still screw up by being overweight, eating crap, not exercising, smoking, etc. all of which ups your potential for problems.

YOU don’t diagnose the problem, a doctor does that. So, do you have a regular doctor? Have you told him/her about your family history and your concerns? What are you current cardiovascular stats? If your blood pressure is high bring it down. If your triglycerides are too high change your diet, exercise, maybe take medication if needed. And so on and so forth.

Bottom line, this is something you have to discuss with a doctor in real life. Too many variables, and your individual situation is likely different than someone else’s.

4

How do you know it really runs in the family ?
WHAT exactly runs in the family ? What form of heart disease ?
… If there is no treatment for it, then why worry ?
Did those relatives have a healthy life style and still got heart disease ?
Can you free yourself of the choices that contribute ? Lack of exercise, work stress, smoking, drinking, over eating, eating poor food choices…
You know, if you avoid all the choices that lead to risks, you really have nothing to worry about.

Some people have livers that basically produce cholesterol , if the person is also an alcoholic… Anyway alcoholics have a risk of many diseases, just ask Joe Cocker.

5

Years ago I had a fake heart attack one night at home alone while my wife was away on business. I got care for the kids and got myself to hospital. My heart problem turned out to be some form of reflux but since I was under the care of a cardiologist by the time they decided this I ended up booked in for cardiac tests. I had them and it culminated in a stress test.

When I went to see the cardiologist to get the results he assured me my heart was fine. He remarked that I didn’t seem pleased with the news and I explained that my father had insisted that he had the symptoms of heart problems, had several stress tests and was cleared but then ended up having triple bypass surgery.

“Oh in that case I think we should do a thallium scan. The stress test does give false results about 50% of the time,” he said.

I asked, “Do you mean you were relying on the results of a test that was the equivalent of just tossing a coin?”

This article, The Tim Russert Paradox does a good job of explaining its fallability.

6

And while he might not have explained it well, no that is not what it meant.

As that article tries to delve into, the value of tests relies on the a priori probability of a positive finding as well as the nature of the test.

For someone at low clinical probability of having a heart attack in the next year a negative stress test can advise that the risk is slightly lower or slightly higher. It’s all about the Bayes Theorem.