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Echo for my husband
My husbands GP recently denied my husbands request for an Echo. I disagree with his decision and I'll explain why, please I would like your opinion if I'm being unreasonable or if I am justified to seek a second opinion.
My husbands father died at age 47 of sudden cardiac death. All we know is he had high cholesterol, and the doctors said the walls between his heart had been ripped apart, he was not overweight and was active military.
His grandfather also died at age 35 of sudden cardiac death, no more info is available.
Our son was born with TGA/VSD/ASD, mitral valve abnormality and is experiencing aortic root and ascending aortic dilation with Z-scores between 3 and 5. Our daughter has progressive infantile scoliosis with minor mitral valve regurgitation and a slightly larger than normal aortic root compared to the rest of her heart.
My husbands last blood work was done 5 years ago, I found his results in a pile of papers and became concerned b/c his Triglycerides was 225, his HDL was 35. His relative risk was only "1.2 times average H". His doctor did more blood work but said his heart was absolutly fine and would not order an echo. I feel given this obvious family history of heart problems and perhaps some potential connective tissue disorder going on, 1 screening echo is not too much to ask?
Thank you.
My husbands father died at age 47 of sudden cardiac death. All we know is he had high cholesterol, and the doctors said the walls between his heart had been ripped apart, he was not overweight and was active military.
His grandfather also died at age 35 of sudden cardiac death, no more info is available.
Our son was born with TGA/VSD/ASD, mitral valve abnormality and is experiencing aortic root and ascending aortic dilation with Z-scores between 3 and 5. Our daughter has progressive infantile scoliosis with minor mitral valve regurgitation and a slightly larger than normal aortic root compared to the rest of her heart.
My husbands last blood work was done 5 years ago, I found his results in a pile of papers and became concerned b/c his Triglycerides was 225, his HDL was 35. His relative risk was only "1.2 times average H". His doctor did more blood work but said his heart was absolutly fine and would not order an echo. I feel given this obvious family history of heart problems and perhaps some potential connective tissue disorder going on, 1 screening echo is not too much to ask?
Thank you.
COMMUNITY LEADER
Most issues with his heart will show up on a stress test and a dissection of the aorta will most likely not show up on an echo either unless it is very advanced. Early detection requires an MRI. Echos are subject to interpretation and can vary from doctor to doctor and lab to lab.
His cholesterol numbers are not horrible. From what I calculate, his LDL is only 117, well under the recommended level. The condition you mention concerning high serum TGLs and low HDL is metabolic syndrome. Remember, TGLs are mostly the result of what we eat. If your husband would cut back on empty carbs like sugars, pastas and breads as well as alcohol if he drinks, he can have a large impact on his TGLs. In addition there is a class of drugs called fenofibrates that are very effective for controlling TGLs and given his history it would be a reasonable request.
I hope all works out for you,
Jon
His cholesterol numbers are not horrible. From what I calculate, his LDL is only 117, well under the recommended level. The condition you mention concerning high serum TGLs and low HDL is metabolic syndrome. Remember, TGLs are mostly the result of what we eat. If your husband would cut back on empty carbs like sugars, pastas and breads as well as alcohol if he drinks, he can have a large impact on his TGLs. In addition there is a class of drugs called fenofibrates that are very effective for controlling TGLs and given his history it would be a reasonable request.
I hope all works out for you,
Jon
Thank you for your honest comment, I do like your idea of requesting a stress test to see what that shows. I do understand the risks of unnecessary tests, I have two children with serious medical conditions so I also understand the risks of not doing tests. I am interested in the echo to show structural images of the heart and false positives are usually not a problem with this kind of imaging (that I am aware of). Aortic dilation does not always present with symptoms until dissection and then the chance of survival is not so great, nor is it something you can always hear through a stethescope unless there is valve involvement and you also can't see thickening or weakening of the heart wall.
His lipid profile 5 years ago was not normal..his triglycerides were 225 (Normal range 30-149) and his total cholesterol was 188, just a few mg away from being high. His HDL was 32 Low HDL being a major risk factor for heart disease.
People with high blood triglycerides usually also have lower HDL cholesterol and a higher risk of heart attack and stroke (taken from the American Heart Assocation website).
We are waiting for his current blood work to come back from the lab and we'll see if the doctor will consent to a stress test in the meantime..thanks.
His lipid profile 5 years ago was not normal..his triglycerides were 225 (Normal range 30-149) and his total cholesterol was 188, just a few mg away from being high. His HDL was 32 Low HDL being a major risk factor for heart disease.
People with high blood triglycerides usually also have lower HDL cholesterol and a higher risk of heart attack and stroke (taken from the American Heart Assocation website).
We are waiting for his current blood work to come back from the lab and we'll see if the doctor will consent to a stress test in the meantime..thanks.
COMMUNITY LEADER
I understand your frustration, however you need to understand the risk of unnecessary tests. If your husband is not symptomatic and has a relatively normal lipid profile, an echo would not be called for in most cases. The problem with doing "preventative" tests is that there is a risk of a false positive which could lead to a more risky, more invasive procedure like a cath which carries a real risk of complication. In addition, he may not be able to get approval from your insurance if there is no real cause for the test in their eyes. That does not make it right, but it is a reality.
I think it would be reasonable for your husband to have a stress test before any imaging including an echo. A stress test will give a good indication of his cardiac health.
Just my 2 cents, I hope it helps,
Jon
I think it would be reasonable for your husband to have a stress test before any imaging including an echo. A stress test will give a good indication of his cardiac health.
Just my 2 cents, I hope it helps,
Jon
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