Testing for heart attack risk isn’t as simple as it seems
DEAR DR. ROACH: I’m 60. Pretty much 100 percent of the people I know, both older and younger, who have had stents installed, had a heart attack FIRST, before getting stents. Why must you have had a heart attack before this procedure is performed? Why almost die before this can be addressed? One buddy had a stress test on Tuesday and a heart attack the following Saturday, and needed four stents before being released to go home. What reliable test can be performed upfront (preventive instead of reactive) in order to potentially prevent the heart attack in the first place? At what approximate cost, since insurance probably will not cover this? — W.A.
ANSWER: Doctors do try to identify blockages in the arteries before there’s a heart attack, but there are several reasons we aren’t always successful.
There is no perfectly reliable test. All tests have false positives (the test says you have blockages, but you don’t) and false negatives (the test says you are fine, but you really do have blockages). The possible exception is a coronary angiogram, which is far too invasive a test to do on people who are not experiencing symptoms, unless they are at extraordinarily high risk.
Most (but not all) people with a heart attack have had warning signs ahead of time. These often are missed or ignored. The signs include the familiar chest ache or discomfort on exertion, but also can be less typical: indigestion, arm pain, stomachache or backache, shortness of breath, sweatiness. Women are more likely to have atypical symptoms, but men can as well. These symptoms are not definitive for heart blockages, but should be discussed with one’s doctor, and in people at risk for heart disease, further investigation can be done. A stress test is a very common test. I’m not sure if your buddy had a positive stress test that wasn’t acted upon in time, or if he was one of the unlucky few whose stress test was normal yet he still had blockages.