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Did you really need that coronary stent?

23 May

by Carolyn Thomas

A New York study has revisited the issue of stent-happy cardiologists implanting the tiny metal devices that help prop open – or revascularize – blocked coronary arteries. Essentially, this study suggests that two-thirds of the justifications for this procedure in non-emergency patients were either “uncertain” or “inappropriate“. For any heart patient who has ever been told by those with the letters M.D. after their names that this type of cardiac intervention was necessary, it’s yet more troubling news. And the fact that this issue simply will not go away makes me wonder why cardiologists themselves are keeping suspiciously mum about the controversy.

When cardiologists do speak up, not surprisingly, many hasten to pre-emptively defend their interventional colleagues. An editorial that accompanied this study’s publication in the Journal of the American College of Cardiology, for example, explained:

“There are certain to be patients rated as ‘inappropriate’ for which almost all competent cardiologists would recommend intervention.”

In other words, pay no attention to the man behind the curtain.  (more…)

Those curious cardiac enzymes

15 May

by Carolyn Thomas

When I showed up in the Emergency Department with textbook heart attack symptoms – chest pain, nausea, sweating, and pain radiating down my left arm – the hospital staff snapped to work and immediately ordered a flurry of cardiac tests. These included an EKG, blood tests and a treadmill stress test. But all test results came back “normal”. I was then told that I was in the “right demographic” for acid reflux before being sent home – less than five hours after the onset of symptoms that day.

I left hospital that morning feeling terribly embarrassed for having made such a fuss over just a little case of indigestion.  It was only much later – after finally being correctly diagnosed, taken directly from the E.R. to O.R. and admitted to the cardiac care unit – when I learned that my “normal” blood tests may have been “normal” that day because I had been sent home too soon.  (more…)

A second opinion from Dr. Google

9 Apr

by Carolyn Thomas

I’ve often suspected that if only the E.R. doctor who misdiagnosed me with indigestion had bothered to just Google my cardiac symptoms (chest pain, nausea, sweating and pain radiating down my left arm), he and Dr. Google would have almost immediately hit upon my correct diagnosis: myocardial infarction, or heart attack. But instead, he pronounced that I was “in the right demographic” for acid reflux. I was sent home that day feeling horribly embarrassed for having made a fuss over nothing but a case of indigestion. As time went by, however, and my debilitating symptoms became truly unbearable, I turned to Dr. Google.

And that’s why I forced myself, despite my embarrassment, to return to the E.R. – but with the pronouncement of that E.R. doc still ringing in my ears:

“It is NOT your heart!”

Many physicians out there, however, are not happy when their patients consult Dr. Google to research troubling symptoms like mine. (more…)

Coronary Microvascular Disease: a “trash basket diagnosis”?

20 Mar

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Dr. Juan Carlos Kaski, Head of the Cardiovascular Sciences Research Centre, St. George’s University of London in the U.K. explains an unusual cardiac diagnosis here that I happen to share: Inoperable Coronary Microvascular Disease (MVD).

When I was at Mayo Clinic five months after my heart attack, cardiologists there referred to MVD as a “trash basket diagnosis” – not because the condition doesn’t exist, but because this disorder of the tiniest blood vessels in the heart is so often missed entirely. A correct diagnosis usually happens only after all other possible diagnoses are thrown out. It’s far more common in women and in people who have diabetes. It’s treatable, but can be very difficult to detect. (more…)

Too embarrassed to call 911 during a heart attack?

12 Mar

by Carolyn Thomas

When I was sent home from the Emergency Department with a misdiagnosis of acid reflux, I felt horribly embarrassed that I’d made such a fuss over nothing (well, nothing but textbook heart attack symptoms like chest pain, nausea, sweating and pain radiating down my left arm).  It then took me two full weeks of increasingly debilitating cardiac symptoms before I forced myself to return to that same hospital, desperately ill yet still not completely certain this could be heart-related. After all, hadn’t an Emergency physician with the letters M.D. after his name told me quite emphatically:

“This is NOT your heart!”

It was only when my symptoms became truly unbearable that I knew I had to go back to the E.R. This extreme reluctance to get help is what doctors call “treatment-seeking delay“ behaviour, and in the middle of a heart attack, it can be a deadly delay. We already know that the average person in mid-heart attack will wait four hours before getting medical help.  Why? One reason may well be that we’re too simply too embarrassed to attract attention to ourselves during a heart attack.   (more…)

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