Who is not afraid of sudden heart attacks especially after having heard of a recent event involving a friend or colleague? Would consulting a heart specialist mitigate such episodes?
It is natural to assume that the degree of narrowing is the most important predictor of a heart attack, but a study of close to 700 patients who underwent invasive coronary angiogram and advanced imaging showed that the degree of narrowing does not predict whether a heart attack will occur. Heart attacks can occur suddenly even in areas of mild narrowing due to blood clots forming in unhealthy arteries!
Following are a few Expert international guidelines to reduce the risks of heart attacks:
For patients with no symptoms, the recommendation is testing for risk factors such as high cholesterol and diabetes.
For patients with a low (less than 10 per cent) likelihood of heart disease (for example, non-anginal chest pain), some guidelines favour treadmill ECG testing.
For patients with a known history of heart disease (for example, previous heart attack), stress imaging is recommended for evaluating new symptoms. The Computed Tomography Angiogram (CTA) is one of these assessments that has recently garnered great interest. It is a non-invasive test using X-ray dye to look for narrowing in the heart arteries. For patients with an intermediate likelihood of heart disease, some guidelines favour using CTA, while others recommend exercise testing with imaging, especially if patients are able to exercise. Routine testing for heart disease with tests such as CTA is not recommended for asymptomatic individuals.
A normal test result can indicate a low risk, but not zero risk. A local review of over 10,000 asymptomatic individuals who took the treadmill ECG test showed that a normal test had an annual less than 0.1 per cent risk of developing a heart attack. In the study, patients with chest pain but a normal CTA result had a low but not zero risk of occurrence (0.9 per cent) over two years. Since low risk does not mean no risk, it is important to manage risk factors such as high cholesterol, smoking and lifestyle choices, rather than relying on testing alone to prevent heart attacks.
Heart attacks can occur suddenly even in areas of mild narrowing due to blood clots forming in unhealthy arteries. While tests cannot totally thwart episodes, you can certainly reduce the risk by being aware of symptoms such as exercise-induced chest discomfort, controlling blood sugar and cholesterol levels, as well as other risk factors.
So the Damocles sword ‘Heart attack’ is here to stay! May be this imminent threat is the one that makes the mortals realise uncertainty of the human life, in spite of the understanding of the anatomy and physiology of the human body, and obliges one to be philosophical!
Credits:
https://www.businesstimes.com.sg/life-culture/choosing-the-right-test-for-heart-disease






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