SHOULD I GET HEART SCAN IT DEPENDS WHICH CARDIOLOGIST YOU ASK
Should I get a heart scan? That's the question many people ask faced with a barrage of advertisements touting the benefits of a heart scan. Now a new study in the New England Journal has poured fuel on the flames of controversy. You know the ads that go something like "My name is Joe Smith and I didn't know anything was wrong but my wife convinced me to get a heart scan and they found out I had blocked arteries". Previously I wrote in healty medical Blog that Medicare had decided to continue to pay for a non invasive test for heart problems called a CT heart scan or ultra fast CT or electron beam CT scan for calcium in the arteries (blood vessels) of people who have symptoms of heart disease.
Video Heart Scan CT Click the Arrow
Heart scans, heart CT scans or electron beam CT test are touted as a non invasive way to look for heart disease and chances of a heart attack. It's not a simple decision even for doctors. It's a common problem in medicine where the old conservatism of many doctors meets science and the profit motive. Doctors would like to find a non invasive test (that is where you don't stick things inside the person) to detect and predict heart disease and who is going to have a heart attack. But do you need an invasive and potentially dangerous angiogram to do it or is there an easier way? Now a new study in the New England Journal has poured fuel on the flames of controversy.
Coronary arteries are the blood vessels that supply the heart itself. If a coronary artery is blocked so that blood doesn't flow to a part of the heart it causes a heart attack. One of the most informative heart tests to look for blocked coronary arteries in the heart is a coronary angiogram. But a coronary angiogram involves inserting a catheter into the blood vessels and has some risks. Generally an angiogram is recommended when there are indications of blocked heart arteries. So for example, when David Letterman had chest pains his doctors wanted him to get an angiogram to look for blockage. A non invasive test for coronary artery blockage would encourage more people to get tested.
Writing about the NEJ study, the NY Times writes there is "a deep rift among heart specialists over the use of the 64 slice or CT angiography which produces mesmerizing 3-D images of the heart and blood vessels". In the NE Journal Study "researchers assessed the accuracy of Ct angiography in identifying blockages of 50 percent or greater in patient's arteries". "Slightly more than half of the patients had obstructive coronary artery disease (blockage)and the CT heart scans were almost as accurate as conventional angiography in diagnosing the blockages".
So what does this mean? Well, like almost everything in medicine, it depends who you ask. According to Dr. Redberg, "the study had failed to address the most important questions about CT scans: whether they improve patient outcomes". Also the CT scan misclassifed the severity of disease in 13 percent of patients she pointed out". On the other hand, Dr. Lima of Johns Hopkins "suggested that Ct angiography could be a good screening test for patients not known to have heart disease who develop sudden chest pain".
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