Medical Tests & Procedures Archive

Two simple steps will improve your odds.

If you have a heart attack and are treated with emergency angioplasty and stent placement, you may be discharged from the hospital in three days … and there's a one in 10 chance you will be readmitted within the month. The risk is even higher for those with multiple clogged arteries. These individuals also tend to have additional medical conditions and take more medications, all of which increase the risk of post–heart attack complications.

A study in the Journal of the American Medical Association examined the outcomes of 5,571 heart-attack survivors who were treated with angioplasty and discharged home in a few days. Those who were readmitted within 30 days tended to have coexisting medical problems, such as hypertension, atrial fibrillation, heart failure, chronic inflammation, pulmonary disease, diabetes, or atherosclerosis in more than one coronary artery.

There's no definitive proof this combination is dangerous.

If a stent was inserted in your coronary arteries to improve blood flow, you may be taking clopidogrel (Plavix) and aspirin to prevent a blood clot from forming inside the stent. This combination of medications has been shown to reduce the risk of a fatal or nonfatal heart attack. As a result, clopidogrel has become one of most commonly prescribed medications in the United States.

Unless you have an MRI-friendly pacemaker, a CT scan may be safer.

If you have an implanted cardiac device such as a pacemaker or defibrillator, you have likely been told you cannot undergo magnetic resonance imaging (MRI). In multiple studies, the powerful magnets in MRI units have caused pacemakers to change their settings and the leads in both types of devices to become superheated. Some deaths have occurred during inadvertent, unmonitored scanning of patients with pacemakers, although the exact reasons are unknown.

A recent study suggests it might, but it isn't the last word.

The wisdom of colonoscopy screening seems obvious. The test enables a physician to examine the lining of the entire colon and to remove small, potentially precancerous growths called polyps during the exam. As a result, it has the potential not only to detect colon cancer early, but also to prevent new cases by removing polyps. It is generally assumed that colonoscopy saves lives because the procedure is good at detecting early disease.

Less frequent testing or home monitoring may be options.

Despite the recent FDA approval of easier-to-use anticlotting drugs, millions of Americans continue to take warfarin (Coumadin, Jantoven, generic) to prevent dangerous blood clots. The most worrisome clots—which can cause a stroke or potentially fatal shutdown of lung function—arise from atrial fibrillation, deep-vein thrombosis, or the presence of an artificial heart valve.

Asking "Is this really necessary?" is always appropriate.

By Thomas Lee, M.D.
Editor in Chief, Harvard Heart Letter

Among the many uncertainties in health care today is the question of whether some doctors might recommend and deliver too much care. Stories like the one about a Maryland cardiologist who implanted hundreds of unneeded stents are rare, and the vast majority of doctors put the people they treat first, far ahead of any personal financial interests.

Options range from doing nothing to surgical repair.

Pelvic relaxation is weakness or laxity in the supporting structures of the pelvic region. Bladder, urethral, rectal, or uterine tissue may then bulge into or out of the vagina. This is called pelvic organ prolapse. It's not a dangerous condition, and it doesn't necessarily worsen over time, but it can drastically affect a woman's quality of life by causing discomfort and embarrassment and limiting sexual and physical activity.

Pelvic organ prolapse was once rarely recognized, and rarely discussed when it was recognized. But today it has become a priority because women are living longer and want to stay active. Many primary care clinicians and gynecologists routinely screen women for symptoms, and a surgical subspecialty called urogynecology has arisen to correct prolapse conditions and the urinary incontinence that often results.

New guidelines clarify the ifs and thens, but the choice is yours.

The release of new clinical guidelines usually gets more attention from doctors than from the people they treat. But anyone with clogged heart arteries or at risk of developing them should know about the updated guidelines on using bypass surgery and angioplasty to deal with such blockages (Circulation, Dec. 6, 2011).

Women who undergo breast-conserving surgery (lumpectomy) for early-stage breast cancer usually receive radiation therapy as a part of their treatment. Radiation kills cancer cells left behind after surgery and helps prevent them from causing a recurrence or spreading to other tissues. For example, in a 2011 study in The Lancet involving more than 10,000 women treated with breast-conserving surgery, radiation cut the 10-year recurrence rate by one-third to one-half. Numerous studies have found that mastectomy (which removes the entire breast) is no more effective than lumpectomy plus radiation in improving survival rates. (Radiation may also be given after mastectomy, depending on the size of the cancer or extent of its spread.)

The main serious downside of radiation is potential damage to the heart. Several studies have found that women who receive radiation for breast cancer have an increased risk of heart disease and death from cardiac causes. It's a special concern for women with left-sided breast cancer, because the heart is mostly in the left chest. Since the early 1990s, technical advances have been introduced to lower the risk of exposing the heart to radiation. But it's unclear how much these newer techniques help — partly because heart disease usually develops more than 10 years after exposure, and follow-up studies have been too short. Also, it hasn't been clear exactly how radiation damages the heart.

Seek help from a heart team when considering your options.

Age and unhealthy habits can harm the aortic valve, a three-flapped structure that ensures the one-way flow of blood from the heart's main pumping chamber to the rest of the body. In some people, the aortic valve becomes encrusted with calcium deposits that stiffen and narrow it, restricting blood flow. When people with this condition (called aortic stenosis) start feeling symptoms — such as dizziness, breathlessness, fatigue, and loss of appetite — quality of life goes inexorably downhill unless the valve is replaced.