July 29th, 2015
Speaking of heart examination, there are so many words that confuse people, or sometimes doctors too. What’s the difference? 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 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 it against the risk of not doing the tests before having any medical test or examination.
However, if it has been determined that you need to have the test, you should go ahead and get tested. 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 a test that is painless and quick. Those under health insurance or government payment scheme also need something that their insurance company covers, which sometimes is difficult since the tests covered by these third parties are usually outdated while the technology advances quickly.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 than the predecessors. It’s up to you and your doctor to decide whether the new technology is worth a try (with an extra cost).
When it comes to choose 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 that there may be complications and side effects. Some treatment ends up causing heart attack, heart failure, or stroke. 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 complications or scenario if not having your disease treated.
Let me give you an example. To test for myocardial ischemia or angina pectoris, there are many tests available. I will recount them for you in an order from the least risky to the most complicated. You can have an EKG test, ECHO test, treadmill, stress test, cardiac MRI, Multislices Detector CT scan (MDCT) and Catheterization 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, Multislices Detector CT scan (MDCT), cardiac MRI, and Catheterization Coronary Angiography.
For treatment 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’ve mentioned earlier about assessing whether not treating it would be a better option.
Again, let me reshuffle and arrange the option of above treatment in a new order, based on effectiveness. The order will be medicine, EECP, and balloon and stent placement. However, coated stent and bypass surgery yield quite similar results these days.
However, it varies from person to person. Each case has to be considered individually because everyone is different, although the disease they have has the same name. 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 sixties, came to see me because he felt tight in the chest while walking to the parking lot after a meal. It happened twice, each time lasted taking about 5 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 narrowed artery of the heart. However, he was scared of Catheterization Coronary Angiography, so I sent him for a 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 risk of each treatment and not treating at all. He told me he needed to think about it and seek second opinion.
I looked around the room and his whole family, who had been there throughout our discussion, was in favor of getting the treatment. I asked again, “Whose opinion do you want?”
He stammered, and his wife cut in, “He wants to see a fortuneteller 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 fortuneteller. 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).
Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.
ข้อคิดเห็นทั้งหมดนี้เป็นความคิดเห็นส่วนบุคคลของผู้อ่าน ไม่เกี่ยวข้องกับเจ้าของเว็บไซต์แต่อย่างใด โปรดแสดงความเห็นด้วยความสุภาพ ถ้าเป็นครั้งแรกที่คุณโพสต์แสดงความเห็น อาจจะมีการคัดกรองเนื้อหาได้ การแสดงความคิดเห็นควรอยู่ในประเด็น ห้ามโจมตีใส่ร้ายบุคคลอื่น หรือทำลิงค์ไปยังเว็บไซต์ที่มีเนื้อหาไม่เกี่ยวข้องกัน ผู้ดูแลเว็บไซต์สามารถแก้ไขหรือลบความคิดเห็นได้ทุกกรณี
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