Unnecessary tests for heart problems

Although I am not a doctor, I have 22 years experience in consulting cardiologists since my heart bypass operation. I wish to point out that many of the investigations for heart diseases are quite unnecessary according to internationally recognised guidelines.

In the US, a research firm, Mediqual, reported that 35 percent of the coronary angiograms they had studied had none of the objective clinical findings used to validate those angiograms in the first place.

An angiogram that is performed unnecessarily carries two types of dangers – the very real risks of the procedure itself (stroke, heart attack or death) and the risk that it will be followed by another inappropriate operation or procedure.

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About three years ago, I failed my treadmill test and despite the fact that I had no symptoms, my cardiologist wanted me to have a coronary angiogram to see how badly my coronary arteries were blocked.

I refused to do it as I wanted a second opinion. However, he arranged for me to have an ‘exercise heart scan’ at the National Heart Institute (IJN) which showed that there was a 25% blockage in a major artery.

He then strongly advised me to have an angioplasty with possible insertion of one or two stents. This would cost about RM20,000. Unconvinced, I consulted two foreign specialists who advised me not to have any treatment unless I have symptoms of heart disease, which are:

  • Pain, usually in the chest, with or with shortness of breath and
  • Breathlessness, usually on exertion, with or without pain.

All responsible will agree that it is quite wrong to operate on coronary lesions that are not causing symptoms. So why do the tests? When cardiologists order such tests, they should do so according to internationally recognised guidelines.

If they do not, one might be tempted to think that they are being over-influenced by financial considerations.

Just for peace of mind, about two months ago, I consulted another cardiologist in Ipoh. This time I passed the treadmill test easily but he still wanted me to get a heart scan done costing RM2,500 by a new 64 slice MRI scanner.

I refused for the simple reason that I had already have passed the treadmill test and I did not have any symptoms of a heart problem.

Fatalities from heart attacks are well-known. It is the commonest cause of death, disease-wise. As a result, most people are over fearful of heart problems, and doctors and cardiologists may take advantage of this fear.

I urge our Malaysian Medical Association to formulate a strict guidelines to control the practice of cardiologists ordering patients to do treadmill tests, scans, angiograms and other what-not.

Without adherence to such guidelines, many patients like me will continue to be subjected to unnecessary, dangerous and expensive investigations.

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