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The Old Tests Were Wrong
If the means to turn off heart disease are already
within our grasp, why don’t most doctors tell you about
it? Surely, if there were some medicine or health
practice that could stop heart disease in its tracks,
he/she would tell you about it!
Think about that for a moment: Coronary disease is the
number one cause of death in America, and most
physicians do not know how to screen a seemingly well
person for hidden heart disease. You may, in fact, know
of friends or acquaintances who passed their annual
physical exam from their family physician, only to die
or have a heart attack shortly afterwards.
Old Habits Die Hard - You Don't Have to! The fact is, the latest research and discoveries regarding the role of hidden plaque in heart attacks is so new that most practicing physicians and cardiologists have not yet been introduced to these revolutionary new concepts. They continue to rely on the test they know and are familiar with - the stress test. Contrary to popular opinion – including that held by many physicians – stress testing is not an effective means of screening people without symptoms for the presence of coronary heart disease. This is such an important issue that it bears repeating: Stress testing is not an effective method of uncovering hidden heart disease. Then why are stress tests performed? Are they worthless? In truth, stress tests can be useful diagnostic tools, but only when used appropriately. People who go to the hospital with symptoms, particularly chest pain, can benefit by having a stress test to reproduce the symptoms. The physician needs to distinguish an impending heart attack from the pain of stomach ulcer, pleurisy (inflammation of the lining of the lungs from pneumonia), esophagitis (inflammation of the esophagus), gallstones, etc. If chest pain is provoked by walking on the treadmill during a stress test, this is suspicious for heart disease. The treadmill test (or a pharmacological equivalent) is often combined with a method of imaging blood flow to the heart muscle such as thallium, or methods to image heart muscle strength such as echocardiography (ultrasound). If there is poor blood flow to a specific segment of the heart’s muscle, then a blockage in a coronary artery is present and your chest pain likely represents warning to a future heart attack. But using a stress test to detect hidden coronary plaque in someone without symptoms is unlikely to uncover anything. This is because the majority of future heart attacks victims are walking around feeling just fine, yet have silent plaque in their coronary arteries. Heart attacks in these people are caused by “rupture” of a “minor” plaque, one that may be causing only 20 or 30% blockage, doesn’t block blood flow, and is therefore undetectable by any stress test. Plaque rupture is a process that develops within minutes -- stress testing will not anticipate this event. What we really want to know is how much plaque is present in a well-appearing person. See Reason #2: Plaque is Best Measure of Heart Disease |
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