Medical Tests & Procedures Archive


Radiation from CT, other cardiac tests can be a problem

Here's what you need to keep in mind.

If you have a heart condition or concern, your doctor may discuss different ways to diagnose or monitor it, including an electrocardiogram (ECG), cardiac catheterization, echocardiogram (ultrasound), radionuclide stress test, coronary CT angiogram, radionuclide myocardial perfusion imaging, or cardiac magnetic resonance imaging (MRI). These tests provide valuable guidance in diagnosing and treating heart disease. But some of them also expose you to ionizing radiation, which can potentially damage cells and increase the risk of cancer. Although no direct link between cardiac imaging tests and cancer has been confirmed, doctors are taking steps to limit the amount of radiation these tests deliver.

Update: Stem cell benefits getting closer

Scientists are transforming stem cell science into stem cell medicine.

Many diseases involve the death of specialized cells that the body cannot naturally replace. A heart attack suddenly kills heart muscle cells. A stroke suddenly kills—and Alzheimer's disease slowly kills—brain cells. A perfect treatment would replace these lost cells, with cells exactly like them, but the body cannot do that on its own.

What clinical studies can do for you

Research studies can give you access to breakthrough treatments.

In January 2007, Debbera Drake got the news every woman dreads. She had stage-four breast cancer. One doctor she'd sought for a second opinion told her she had just two years to live.

Breakthrough in aortic valve treatment

Transcatheter procedure eliminates surgery for some.

Cardiologists are increasingly enthusiastic about a new technique for replacing failing aortic valves without open-heart surgery. As discussed in the February 2012 Harvard Heart Letter, transcatheter aortic valve replacement (TAVR) lets a new valve be delivered to the heart through a catheter inserted in an artery in the groin. In clinical trials at Brigham and Women's Hospital, Massachusetts General Hospital, and 24 other academic medical centers, TAVR was clearly beneficial in very sick people with damaged aortic valves who were poor candidates for surgery. Interest in the technique continues to grow, since the results of TAVR in healthier people with valve disease are encouraging.

"TAVR is the most exciting therapeutic innovation in cardiovascular disease in the past 20 years. I have patients whose downhill course has been completely reversed by this technology," says Dr. Andrew Eisenhauer, director of the interventional cardiovascular medicine service at Brigham and Women's Hospital and an assistant professor at Harvard Medical School.

Avoid another hospital stay

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.

Yes to heartburn meds plus clopidogrel

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.

MRI and pacemakers: A risky mix

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.

Does colonoscopy save lives?

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.

Take the hassle out of taking warfarin

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.

Overuse, underuse, and valuable use

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.

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