Putting your heart to the test

Concerning heart examinations, there are so many words that confuse people, and sometimes doctors too. What's the difference between the techniques? What does each of them do? Which one do you need?

Before getting there, let's first be clear about one thing. Every treatment and examination comes with risks and a chance of inaccuracy (or predicative value). However, not getting tested can be just as risky (or riskier). It is important to assess the risks and possible complications, and weigh those against the risk of not doing the tests before having any examination.

However, if it has been determined that you need to have the test, you should go ahead. Now the question is, what test is best if you want to know your heart's condition?

For doctors, accuracy determines what test is best, but for patients, they want one that is painless and quick. Those under health insurance or a government payment scheme may also need something they are covered for, which is sometimes a problem since the tests covered by these third parties are usually outdated while the technology advances quickly.

New tests are usually more expensive, but this doesn't mean they do a better job. It's up to you and your doctor to decide whether the new technology is worth a try (and the extra cost).

When it comes to choosing the best treatment, there are many factors that you should consider. What is the chance of you recovering from your health problem once you know the result of the test? How complicated and painful is the procedure? Does it prevent the problem from recurring?

Also, keep in mind there may be complications and side effects. Some treat- ments end up causing heart attacks, heart failure, or strokes. If the chance of these complications is high, you might need to reassess whether you really want to take the risk.

But you also need to consider the chance of similar scenarios if the disease is not treated.

Let me give you an example. There are many tests available for myocardial ischemia, or angina pectoris. From the least risky to the most complicated they are: an EKG test, ECHO test, treadmill, stress test, cardiac MRI, Multislice Detector CT scan (MDCT) and Catheterisation Coronary Angiography. The last two tests involve the aid of a contrast medium.

Now, I will reshuffle the order and start from the least accurate to the most. The order will be EKG test, ECHO test, treadmill test, stress test, MDCT, cardiac MRI, and Catheterisation Coronary Angiography.

For myocardial ischemia or coronary artery disease treatment, from the least risky to the most, available options are exercise (under supervision), medicine, EECP, balloon angioplasty and stent placement, and surgery (or bypass surgery). Don't forget what I mentioned earlier about assessing whether or not treating it would be a better option.

Again, let me reshuffle and arrange the options of the above treatments based on effectiveness. The order will be medicine, EECP, and balloon and stent placement. However, coated stent placement and bypass surgery produce quite similar results these days.

However, it varies from person to person. Each case has to be considered individually. What works for one person might not work for another.

What's more, two doctors treating two patients with the same problem could end up with drastically different results.

A patient of mine, in his 60s, came to see me because he felt tightness in the chest while walking to the parking lot after a meal. It happened twice, each time lasting about five to 15 minutes. First he assumed it was a stomach problem, but his medicine did not help.

After he told me what happened, I could tell right away (without any test) that he had a narrowed artery of the heart. However, he was scared of a Catheterisation Coronary Angiography, so I sent him for an MDCT scan.

It was found that he had three narrowed arteries, which could be easily treated with balloon angioplasty and stent placement. I explained the pros and cons as well as the risks of each treatment and not treating at all. He told me he needed to think about it and seek a second opinion. I looked around the room and his whole family, who had been there throughout our discussion, was in favour of getting the treatment. I asked: "Whose opinion do you want?"

He stammered, and his wife cut in: "He wants to see a fortune teller to ask what day would be the most auspicious to get the treatment."

I knew just how to handle situations like this. I said: "Then you should also write down my birth date and time.

"But maybe you don't need to see your fortune teller. Mine just told me the other day that I will be very successful in everything I do this week. I'm not so sure about the week after, though."

As soon as I finished that sentence, he agreed to get the treatment. It all went well, and he could go home the next day.

In the end, it was a success like the forecast (by me).


Dr Nithi Mahanonda is a consultant cardiologist and interventionist at the Perfect Heart Institute, Piyavate Hospital. Visit his website at www.drnithi.com.

About the author

columnist
Writer: Dr Nithi Mahanonda
Position: Writer