Screening for heart disease (go ahead and post your thoughts - thanks!!)

Hi everyone

Some of you will know me from previously.

I would really value your thoughts on the following:

*  If people were to be screened to check for heart disease what would be the best tests/checks that they could have?  a)  in and ideal world  b)  realistically?

*  why do you think it's not routinely done?  (is it cost?  or is there a medical reason...ie that because there is heart disease pressent in most people the tests would not really tell us much more?)

I'm posting from England so I am thinking in terms of the NHS paying for this, but of course feel free to comment according to your own healthcare system.

Thanks again  :-)

Rosemary

[ChatterAlly]

Rosie, I think the heart scan would be a great way to start. If there is a need for further testing, then it would be evaluated at that time.  A lot of times in this city clinics will offer these scans for about $200 to raise awareness.  Realistically, I just don't think people realize there is a need to be screened even if there is a family history of it.  And as far as it being routine, I think it is both cost and medical reasons.  Ally

[jrbon]

ChatterAlly,
Can you explain what do you mean by heart scan?

Rosemary,
My realistic one would be:
1) Chest Xray: Dilated heart, Structural problems
2) EKG: Arrhythmias, Ischemias
3) Chest auscultation: Valvular issues.
4) Blood test: Cholesterol, Homocysteine, hs-CRP, IL-6, alfa-tumoral factor, Vitamin D, Selenium. TSH, Iron.

I do not think  is a problem of cost... I think there are not cardiologist enough to screen the whole population... by the way, another question will be: what the target population should it be??

Jesus

[Rosemary349]

thanks for your thoughts!!!

I was wondering about approaching my doctor with a view to having a charity event in my hometown, to raise awareness of the need for prevention.  There are always plenty of charity events....

I was thinking of one that involves a screening of the town's population over the age of 40.  It would be voluntary - just those that attend the event, but publicised so that hopefully people would come along.

I'm just doing my research though, cos although I can see the benefits of screening....like a body scan type thing, I wonder if it could cause unnecessary alarm because most people have subclinical heart disease.....so a poor scan result might not necessarily mean that the person would ever suffer heart problems.

It's easy for me to think this is a cost issue only, but if i am less skeptical for a moment, there may be other ehtical reasons that have been considered for not scanning people.....

I'll let you know anything i find out but meantime any more thoughts from you or anyone on this forum will be so helpful.

I could still raise awareness at this little event with a routine health check, bp, cholesterol, bmi, and education.....thoughts?

thanks so much!!!

Rosemary

[Rosemary349]

Just an afterthought, I'm curious that they offer those scans in your city.

Would you think it's helpful or do you think it could throw up too many 'false positives' ie people being told they have lots of plaque but no one knows if that will eventually cause problems or not?

There is a company that puts leaflets in our doors regularly here, I'm sure they would love to do something at an event to raise publicity....but my reservation is that they are a business.....would like to get our NHS doctors on side if it's a good idea....and if it isn't then obviously it is better to leave it.

just thoughts...

[Rosemary349]

anyone else have any thoughts?

Trying to take some positive action which can only be a good thing, but want it to be informed.

thanks  :-)

[ed34]

In reality screening is useless. How many millions of people would require screening? and also, they may be 'clear' today, but next year start to form blockages. Screening could also have a negative effect. For example, a heavy smoker who eats fatty foods could be screened today and be found clear. He/she would think "oh well, smoking isn't damaging me then or the foods" and carry on with a deadly lifestyle.
Personally I think the only situation which will work, is when they finally discover exactly how atherosclerosis works, what the mechanics are. Then a prevention can be developed to rid everyone of the possibility of this dreadful disease.

[Rosemary349]

Thanks Ed

I totally agree - to find what is causing atherosclerosis would be far better.  I for one am willing to support THIS cause.

Do you think there would be any other reason why they don't screen?  I mean do you think the decision not to screen nationally is because they think it would be useless for the reasons you've mentioned?  Or do you think it's financial?  but then if it is how can they afford screening of women for cervical cancer, etc......

makes me think it must be because screening for heart disease has a downside....not beneficial enough...

thanks for your reply  :-)

[bubbaben]

Not sure there is any kind of test that would or could find everything....In my life time I have had 5 surgeries that had nothing to do with my heart....I have had many chest exrays over my life time .I have had many heart scans over my life ...  I was in the hospital when I thought I had a heart attack in my 40 and they found no problems...I have had 4 stress test thru out my life  because I smoked ..They found nothing...I had what was called an arterial heart scan  15 years ago  and they found me all clear......Yet  6 months ago at the age of 61  they found that I had a single coronary artery that should have taken me before I reached the age of 20....In my opinion  doctors have to start thinking outside the box and we as patients know how we feel and should not always settle for theres nothing wrong....

[ed34]

I just think too many test are inconclusive. Many people still end up having an angiogram only to find that they have no blockages.
I do also think it's unrealistic financially, every single person in the population would have to be screened several times in their lifetimes. Screening for cervical cancer is not really expensive, a Nurse can take a smear for examination, plus it isn't the whole population, it's females in a particular age group.

[Rosemary349]

Thanks for the response guys

bubbaben I hope you are getting treatment that you are happy with now.  Curious as to what test finally revealed the problem.  Just goes to show how strong your system is that it has withstood this.  All the best with future treatments  :-)

ed34 - it must be just that, the tests are inconclusive, there are false positives, and financial considerations.  It just gets me that if my dad had even just had a cholesterol check and ecg and a stress test, his condition might have been picked up.  Especially as one artery was blocked to a pin point.  of course i won't ever know but I think of how many others might be picked up easily like this but don't get checked.  

As far as age when screening, 35, then 55 then 65 for men?  and 55 and 65 for women?

the wierd thing is people can ask for this anyway but most don't know it.  Maybe it could remain as simple as an ecg check, cholesterol, bp and stress test....it won't pick up everything, but if it would have picked up my dad's condition, then it will pick up some....interested still of course on what test pick up bubbaben's condition finally.  :-)

anyway, no need for a reply if you've had enough with this, just something i wonder about.

[ed34]

"As far as age when screening, 35, then 55 then 65 for men?  and 55 and 65 for women? "

Well, if I go by my own experience, then this wouldn't have helped me at all. I had a stress echo in Jan 2006 and EKG which were great results. However, in Feb 2007 I had an MI where an Angiogram revealed, LAD totally blocked, RCA totally blocked and LCX 98% blocked. I was living on one vessel which was 98% blocked. In March 2011, another MI, LCX had 2 more blockages over 90%. Recently, Sept 2011, had 2 more stents to LCX because more blockages were forming.

The best solution for screening I think is education. I know not everyone gets symptoms, but the vast majority do. If people are educated as to what Angina is and how/when symptoms occur, maybe people would get to the hospital for treatment much sooner.

5 years ago, my Mother phoned me and asked me to pop over one evening because she felt really ill. When I arrived she was on her hands and knees gasping for breath. She had recently had the flu which confused the diagnosis. She was scared stiff of hospitals and I knew very little about the heart or diseases etc. I disregarded her requests to not call for an ambulance, and the paramedics were there in minutes. They put her on oxygen and did an EKG which was normal. They took her to hospital and SIX doctors, yes SIX, examined her. They ruled out her heart and said it was a problem with her lungs and she would be fine. It was around 11.30pm and they told me to go home and phone in the morning. The following morning 8am, I called the hospital and nobody seemed to recognise her name. I thought this was very odd, so I drove there. At the reception I was asked to accompany a senior nurse into a side room, where she handed me a bereavement leaflet, and said how sorry she was. My Mothers heart stopped three times in the night, and they couldn't restart it on the last episode. A post mortem revealed coronary artery disease. If I knew then what I know now, I know she would have survived and so I can fully understand how you feel Rosemary. You kick yourself a lot. I now see it that we all die one day, nothing will stop that and one day, everyone will meet up again in a much better life.

[Rosemary349]

I am so sorry to hear about your mum, I do remember you mentioned some parts of this before.  What gets me is that we think we could save them if we'd known better but somehow, the doctors that do know better still miss it.

but there's no point in negatively evaluating them either as it does us no good in the long run!

With my dad it was two days of indigestion which he was convinced was a takeaway that my mum had bought on the friday night. He died on the monday due to having had a silent MI that went untreated for three days.

What do we need to know about angina?  I mean if i got out of my seat now and ran down the road my heart would have ectopics, I would feel a rush of warmth all round the chest and arms, etc....and obviusly be out of breath.....when angina is non-classic how do we know?  I would also have indigestion but that would be because i've just eaten.  My body does not like sudden exercise, but then right now i'm on beta blockers because of night palpitations.  If i go to my martial arts class (which i rarely do these days!) we warm up slowly and i notice a rapid heart rate, even some ectopics occasinally but no warmth or rush in the chest and arms.....it's just hard to know when it would be angina.....

if some customer at work shouts at me i immediately feel something, like an energy and slight heaviness run down both arms from the centre of my chest.  Before dad died it never bothered me, i thought it was adrenalin....but nowadays i wonder.  I used to take on difficult customers, loved that feeling in my chest (so maybe it was adrenalin) and people used to say i was fearless......now i avoid them, or ask them to wait a moment and walk away and ask someone else to deal with them.  They know why so they do now.  

and i wonder if with my dad similar feelings just grew in intensity over the years so it was hard for him to know there was anything different going on....

anyway just thoughts.

if you could go back n time what woudl you have got the doctors to do for your mum that night?

I think you are right, we need to sometimes be at peace with this all too.

[Rosemary349]

Re all those symptoms i've mentioned the doctors tell me not to worry about any of them.  I do have a lot of anxiety about what happened to dad as i was there and because it appeared so sudden (although it wasn't - he'd had silent disease gone untreated or monitored for years)....so i notice every little thing about my heart.

The night palpitations they are saying is heightened adrenalin and/or hormones as it happens at certain times of the month.  The feeling in my arms when customers shout or if i'm threatened they say is most likely adrenalin or could be coronary spasm but that this is common and doesn't affect prognosis.  They say it would be a worry if i get that heaviness when exercising but i don't, ever, just ectopics and breathlessness if i over did it.

[jrbon]

I fully agree with your point that the best that we can do for prevention it is education ....

Now the point is, have you/we found any good cardiac prevention educational material?

I think I have seen many advises on detection and what to do while suffering a heart attack.. but more subtle things that could give a clue in advance to go to the doctor and what to expect from him... I am not able to recall anyone.

Jesus

[bubbaben]

Hi Rosemary  the anomaly was found thru a heart cath then confirmed thru a 64 slice scan....  I had a cardio Dr. who just wasnt comfortable with sending me home so he ordered the test ....I live in the Chicago area an as soon as Him and I talked  we decided that I should go up to the ACHD  Clic at Mayo...All has gone well just on medicine  (lots of it )  now and will be on it for ever....Some of the best docs I have met .......  Like Ed I do believe not just heart but for anything we feel is wrong with ourselves we cannot not always except the nothing is wrong answer....I know I never will...

[bubbaben]

I would also like to know how many people have asked their doctors questions based on what they have read on forums such as this one....I know  I have   .....Thats education

[ed34]

"Now the point is, have you/we found any good cardiac prevention educational material?"
Well I think that the first point to educate people on would be exercise. More and more people are doing office work and not having proper exercise. They get all kinds of muscular issues and suffer the stress of work. I think if people do an exercise routine several times a week, they would more likely be able to identify if a heart problem COULD be appearing. Most people who catch symptoms before MI are those who exercise. People who do no exercise wouldn't really notice blockages until they are very severe. So, the top of my list would be exercise. The education needs to be aimed at all ages too. More and more children and simply sitting at home playing computer games and doing nowhere near enough exercise.
After exercise would be diet because unless you eat a proper diet, exercise is more difficult. The two are very important together.

[bubbaben]

I have read articles at the Cleveland Clinic  web page..The mayo Clinic web page    and the Texas Heart Institute web page.......So yes I would say ther is plenty of material to tell us how to prevent ......The problem is most of us dont educate ourselves untill we have a problem.....In Texas they are testing thousands of student ateletes for heart problems  in Illinois there is a mobile test truck that goes around to schools in the Chicago area and test high school athelete 63000 since I believe 2006.....Thats what we need more of  ...Teach the kids in high school and test as many as we can....   Theres big companies wasting donation money on crazy stuff that could be better used.....

[vienna13]

Agree with ed34 Education is the key:…Exercise, proper diet as he put it first…. I would also add, avoid stressful situations and not as they say “as much as you can” :) but completely. It is a challenge but not impossible.