Medical Tests & Procedures Archive

Articles

Heart Beat: Just-in-case electrocardiograms not recommended

Checking your heart's electrical activity with an electrocardiogram (ECG) or exercise stress test makes perfect sense if you or your doctor suspects cardiac trouble. What if you feel fine — no chest pain, shortness of breath or tiredness, or other symptoms of heart disease? Should you have an ECG or exercise stress test to "check under the hood" for undiscovered heart disease? No, says the U.S. Preventive Services Task Force, an independent panel of experts whose recommendations help define high-quality preventive health care for Americans (Annals of Internal Medicine, Sept. 20, 2011). The recommendation reaffirms the group's 2004 advice.

The task force found no evidence that a screening ECG or stress test — screening means checking apparently healthy people to see if they have an undiagnosed condition — will change your cardiovascular risk classification or the way you manage your heart health. And while an ECG is one of the safest tests around, it can lead to additional tests such as an angiogram or a cardiac CT scan. Those methods come with their own risks, such as the chance of bleeding or stroke with an angiogram, and radiation exposure with cardiac CT.

Heart attack treatment happening faster

Good news for heart attack victims: hospitals across the country have shaved more than 30 minutes off the time it takes to begin artery-opening angioplasty and stent placement, the best treatment for a heart attack in progress.

Hospitals use a measure called door-to-balloon time (named after the balloon used to open an artery) to track how quickly they can get a patient from his or her arrival at the hospital to the start of angioplasty. In 2005, the median door-to-balloon time was 96 minutes. At the end of 2010, it was 64 minutes (Circulation, Aug. 30, 2011). That's a remarkable improvement, prompted by efforts from the American Heart Association, the American College of Cardiology, and other organizations.

Atrial ablation on video

Atrial ablation, also called percutaneous pulmonary vein isolation for atrial fibrillation, is a medical procedure that uses small bursts of electricity to stop patches of heart tissue from sending out "beat now" signals that cause the upper chambers of the heart to beat fast and wildly. As part of its Diagnostic and Therapeutic Cardiovascular Procedures section, the journal Circulation has posted a video of the procedure. This particular atrial ablation was done by Drs. Gregory F. Michaud and Roy John, of Harvard-affiliated Brigham and Women's Hospital.

October 2011 references and further reading

Blood vessel disease linked to dementia

Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, Petersen RC, Schneider JA, Tzourio C, Arnett DK, Bennett DA, Chui HC, Higashida RT, Lindquist R, Nilsson PM, Roman GC, Sellke FW, Seshadri S. Vascular contributions to cognitive impairment and dementia. Stroke 2011.

Angioplasty via wrist artery safe, effective

Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, Budaj A, Niemela M, Valentin V, Lewis BS, Avezum A, Steg PG, Rao SV, Gao P, Afzal R, Joyner CD, Chrolavicius S, Mehta SR. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 2011; 377:1409-20.

Update on vibration therapy for bone health

Can gentle vibration improve bone density and prevent fractures after menopause?

Soon you may be hearing a lot about low-intensity vibration therapy for strengthening bones and reducing the risk of fractures. Two low-intensity oscillating devices designed for home use are coming onto the market, and the Agency for Healthcare Research and Quality (AHRQ), which advises the federal government on health care matters, is expected to issue a report highlighting the evidence as well as the many unanswered questions about this unique approach to bone health.

How to get rid of warts

Warts are an unsightly nuisance that can take a year or more to go away on their own. Several effective, noninvasive treatments are available.

Ask the doctor: Is abdominal surgery riskier if I am overweight?

Q. I am overweight and need abdominal surgery. Does being overweight make the surgery more difficult and add to the complication rate?

A. We all have a fair amount of fatty tissue in our abdominal cavities that surgeons must deal with during abdominal operations. The more fat you have, the more difficult the operation is for the surgeon. Excessive fatty tissue impairs access to the surgical site. It can also make the surgery itself — the cutting of tissue — more complex. Operations on obese patients tend to take longer for these and other reasons.

COURAGE not followed by action

Results of landmark trial have little effect on use of angioplasty.

The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial should have been a game changer for people with stable angina (chest pain from cholesterol-clogged coronary arteries) or a severe narrowing in one or more coronary arteries. In such individuals, COURAGE showed that artery-widening angioplasty plus stent implantation was no better than optimal medical therapy at preventing heart attacks or improving survival. In other words, it made sense to first try medical therapy — that is, drug treatment and lifestyle changes — and turn to angioplasty if it didn't work.

The crucial, controversial carotid artery Part II: Treatment

The carotid arteries carry oxygen-rich blood from the heart to the front half of the brain. But these crucial arteries can become narrowed by the cholesterol-laden plaques of atherosclerosis. Blood clots, or thrombi, can form on the plaques, then break off and travel as emboli to the brain, where they lodge in small arteries, interrupting the vital flow of blood to brain cells. If the interruption is partial or brief, the brain cells recover; the patient experiences a transient ischemic attack (TIA) with no permanent damage. But if the blockage is complete, brain cells die, producing a stroke.

In many cases, a TIA warns of a future stroke, giving doctors time to perform a carotid ultrasound test to see if the artery is mildly (less than 50%), moderately (50% to 69%), or severely (70% to 99%) narrowed. Once the diagnosis of carotid stenosis (narrowing) is established, several treatment options must be considered.

"Just in case" artery scans offer little or no payoff, possible harm

The carotid arteries that run up either side of the neck are prone to becoming narrowed by cholesterol-filled plaque. A test called carotid ultrasound can identify a narrowing, also called a stenosis, quickly, safely, and without any immediate potential for harm. This test makes perfect sense for someone experiencing lightheadedness, memory loss, or the warning signs of a stroke or mini-stroke.

In people who have their carotid arteries checked "just in case," ultrasound doesn't do much good. University of Wisconsin researchers tracked almost 600 people who underwent carotid ultrasound for this reason. A year later, those whose scans had shown a significant narrowing were no more likely to have their blood pressure or cholesterol under control — two key steps for managing carotid stenosis — than those whose arteries were clear, or to have made healthy changes in diet, exercise, and other long-term health behaviors (Archives of Internal Medicine, March 28, 2011).

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