Q: I am 49 and have a family history of heart problems, all on my father’s side. My father passed away at 48. My uncles passed away at 43, 52, 55 and 62. I have two cousins that passed away at 40 and 55. All heart attacks. During my last physical I asked my doctor for a more thorough look at my heart. He referred me to a cardiologist.
I am on Azor and Lipitor. When not on Azor, my blood pressure is 150s/100s. I went to the cardiologist and had a good EKG and blood pressure of 120/70. The cardiologist made me feel like I was a hypochondriac about coming to him. I had to ask for a stress test and a way to get a better look at my heart. Am I wrong to want to get a preventive look at my heart rather than wait till I have chest pains or something worse?
A: Surprisingly, there are two schools of thought on your dilemma. The first is that an EKG should be performed as part of a routine examination, perhaps in conjunction with lab testing to check for sugar levels, high cholesterol readings, anemia, and other concerns based on your history. An EKG will determine how fast your heart beats, if there is an arrhythmia (abnormal rhythm), or other issue that may need to be addressed. Should an event occur in the future, a quick comparison can be extremely helpful.
According to the U. S. Preventive Services Task Force, new guidelines first released almost 10 years ago indicate an EKG given to a healthy patient while at rest will not predict a coronary event, nor will it predict heart disease. In fact, their guidelines carry a grade “D” recommendation, meaning a physician should not even offer the test. Stress is emphatically placed on the fact the recommendation is for individuals WITHOUT symptoms. If an EKG is performed and found abnormal, it likely represents a false positive which can lead to needless, expensive and perhaps even invasive additional testing. The group felt a physician can estimate a person’s risk by using total cholesterol, HDL and blood pressure numbers, along with information such as age, gender and smoking history.
The American Academy of Family Physicians does not recommend routine EKGs as part of a periodic health exam in adults without symptoms; however, The American College of Cardiology Foundation and the American Heart Association feel a resting EKG is “reasonable” to assess the risk in an adult with no symptoms who has high blood pressure or diabetes and can be considered in others without the medical problems indicated.
You’ve already asked for a stress test. I don’t know if you had or questioned having a nuclear stress test, angiogram, or other work for a more in depth look; however, were I you, especially with such conflicting reporting, I would be extremely uncomfortable playing the odds and hoping for the best. You have a terrible family history that hasn’t been considered in these confusing studies. As hypochondriacal as it may appear, I recommend you make an appointment with another cardiologist for a consultation. Provide your family history and a printout of recent testing. Find out what’s next on the to do list that will either address the issue or give you peace of mind.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Coronary Artery Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, M.D. Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
