I had my annual cardiac workup about a month ago. I'm a 49 year old male, still 50 lbs overweight but otherwise in good health. Don't smoke, don't drink, no family history, controlled cholesterol and blood pressure. In 2005 & 2006 I had a Thallium Stress test, Echo and blood work, all normal. This year when I went in for my initial check up, my cardiologist only ordered the Echo and blood work, no stress test. She based this on my low cholesterol level (TC 163 and LDL only 58), my exercise tolerence and weight loss ( I do 45 minutes and 500 calories every day on a treadmill with no symptoms and have lost 50 lbs this year), normal blood work and my normal test results the past two years. I have to agree that I have no heart related symptoms like chest pain or SOB so I guess she's right. When I got the Echo back, besides a slightly enlarged LA (blood pressure is controlled at 110/70), everything was fine, EF of 60%, all other chambers normal size, only trace reguritation in my tricuspid valve, all other valves good, no wall motion abnormalities. She told me that my only complaint, the occassional PVC was not an issue as my heart is structureally fine. When we were finished going over the report, she said I don't really need a cardiologist at this point and that my family doctor could manage me during my annual physicals and I should only need to see her if I started with new or changed symptoms, I guess that's a good thing.
My questions is how often should I have a stress test and echo? Should I just leave it up to my family doctor and let him know if anything changes?
Provided that you don't have diabetes and you remain active, you should have a stress test if you have any symptoms of heart disease. Stress test performed in asymptomatic patients can lead to further test such as stents or even CABG, none of which in that setting have been shown to prolong life expectancy. So although some patients at high risk ( such as those with diabetes or history of prior heart disease) get stress tests without severe symptoms or with atypical symptoms, patients at low risk without symptoms ( like yourself) are more likely to have a false positive stress test than an actually positive stress test. So I you should undergo a stress test if you experience mild symptoms of coronary disease ( mild sob, or chest pain at high work loads), and if you experience moderate to severe symptoms ( chest pain at rest or with mild exertion) to forgo the stress test and go straight to diagnostic catheterization.
As a side note, my cardiologist only ordered the echo because during the conversation at my check up I mention I had been feeling fatiqued due to a new job so she wanted to make sure me heart "was still as strong as last year'. The reason I started seeing a cardiologist in 2005 was because my family doctor wnted to rule out cardiac issues for chest pain that was later dx as reflux and rhuematory arthitis in my rib cage. With the medications he gave me the pains have been gone.
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