Here, I answer some of the questions patients asked me over last few years.
Q. I used to have high blood pressure (BP) before. Since I started taking medicines for it, BP is now under control. Can I stop my medicines now?
A. The fact that your BP got under control after you have been put on medicines, there is a very good chance your BP will go back up again after you stop the medicines. You should shift your focus from stopping the medicines to adapting a healthy lifestyle that includes optimal diet and weight, regular exercise, low salt diet etc. Need for BP medicine is dynamic and doses need to be adjusted (up or down) based on your body's requirement.
Q. I have periodic chest discomfort. My ECG and echocardiogram is normal. Can I be reassured that I don't have heart disease?
A. Unfortunately, ECG and Echo tells if there is any active or previous damage. It doesn't predict possibility of having a future heart related issue. Based on individual patient's clinical profile, further investigations may be necessary to analyze overall future risk. Such tests can be in the form of Stress Test like Treadmill (TMT), Stress-echo, or advanced forms of heart scans like SPECT and cardiac MRI. In few situations, coronary angiography may be required as well.
Q. Is it possible to get a heart attack even after successful stent placement?
A. Absolutely. Our body, due to various reasons, forms blockages into blood vessels that supply blood to our heart (coronary arteries). While stent opens a severe block at time of need, it does nothing to prevent body from forming further blockages. Our body may continue to form blockages in other branches of coronary arteries which may lead to heart attack. In fact, body identifies a stent as a foreign material and tries to block it aggressively. Human body's behavior is changed by 2 things: medications and lifestyle. They both help preventing future blockages. While these measures work very well, they are far from being perfect.
Q. I have hypertension and even after taking multiple medications my BP is not controlled. What should I do?
A. Poorly controlled BP even when someone is taking multiple medicine calls for cause analysis rather than just changing medicines. Few causes of uncontrolled BP even while taking multiple medicines are:
1. Salt intake more than recommended 2. Excessive weight/obesity 3. Obstructive sleep apnea (related to snoring) 4. Poor quality medicine 5. Faulty BP machine giving wrong reading 6. Issues related to other organs like kidney, thyroid, adrenal gland etc. 7. Significant psychological stress 8. Taking lots of pain killers
One should be evaluated for each of so called 'secondary' causes of uncontrolled BP.
Q. I feel heart beating very fast occasionally. This lasts only for few seconds. I otherwise feel fine. My ECG and Echocardiogram are normal. What else I should do?
A. Episodic palpitations (feeling of a fast or irregular heart beat) can be due to abnormal heart rhythm, commonly grouped as 'arrhythmia'. This can be tricky to identify at times because by the time ECG/Echo is done, the symptoms as well as arrhythmia may be resolved on its own. Best way to identify such issue is through prolonged continuous heart rhythm monitoring like Holter, Event Recorder etc. Also, thyroid should be checked.
Q. What is the difference between angiography and angioplasty?
A. A detailed description on this topic can be found here.
Q. I just got tests done last month. Why do I need to repeat it?
A. There are many reasons to repeat a test. I will list a few:
1. To evaluate new problem: If doctor suspects a change in body's condition, based on your symptoms, signs, or other tests, or change in medications. With a new clinical situation, one shouldn't assume that a value obtained previously will still be the same.
2. To see a trend: At times values are outside of normal range for a particular person, and physician may want to look at whether it is getting worse or better.
3. To compare from previous: Particularly for image based tests like X-ray, ultrasound etc. Comparison is basic essence of clinical medicine. The whole idea of evaluating somebody is to compare it to normal.
4. Discrepancy: Sometimes clinical suspicion and test results don't match. In this case, doctor may ask to repeat a test to ensure it's not an error or matter of chance.
5. Variability: Quality of certain tests rely heavily on expertise of the one performing it, for example ultrasound, echocardiogram, biopsies, angiography etc. Here, to be confident about a result, doctors at times would like to get the test repeated by someone whom he/she considers an expert at it.
6. Additional information: Infrequently a test is done to provide screening information and a dedicated test needs to be ordered next to get additional information. For example: a CT scan of abdomen may reveal some liver abnormality. A repeat CT with focused liver-protocol may be needed to evaluate the abnormality more precisely.
Q. I have a scheduled appointment with a cardiologist. Should I bother to bring by endoscopy report as well?
A. Yes. As a general rule, please bring all your previous papers, including current and old medicines that you have. A doctor may review those at his/her discretion but having the information handy is very important. Also, if you have images/CDs of previous tests/procedures, those are very helpful as well.
Q. I want to know more about my doctor. Where I find about it?
A. The best way is to ask him/her directly. Here are some of the questions which are fair to ask to your doctor:
1. When and where did you get your medical education?
2. For how many years you have been practicing?
3. How may procedure have you done so far? (This is relevant only pertaining to the procedure the doctor plans on doing to you or your loved one)
4. How many similar patient you have treated before?