I had done well. A grateful Mr Smith. A bottle of wine and that nice, warm feeling you get when all ends well.
Mr Smith, the smoker. 40 plus a day and no less.
Mr Smith, the keen jogger. 6 miles a day and no less.
Mr Smith, the man who had just crossed the milestone of 50 years.
Life was good for Mr Smith, but lately this had been disturbed by those odd twinges of pain in his chest, which had resulted in three hospital admissions. Each time he had gone through the same ritual: rushing ambulance, siren screaming, light flashing. Serial ECGs. And ouch! Those numerous needles and cannulations. And each time after a stay of few hours in hospital he had been sent home with a little discharge note: “Non-cardiac chest pain. ECGs, Troponins normal.”
The ritual was getting boring and Mr Smith anxious.
“Why doctor, have I not seen a cardiologist after so many hospital admissions?”
“Because, the chest pain was not from heart?”
“How can you be so sure? How can those doctors be so sure? You are not the specialist.”
“Um..you are worried about heart attack…um…smoking….”
“Lets not go there doctor. Will you please refer me to see a cardiologist?”
And I did.
This man has presented three times to the hospital with chest pain and on each occasion all investigations were normal. He is lean and fit and runs 6 miles everyday. His biggest risk factors are his age and smoking. The first one no one can help him with. As for the second he does not want any help. He is very anxious about these episodes of chest pain and has requested your valued opinion.
The good, wise cardiologist knew the secrets of his trade well. He made Mr Smith run on the treadmill.
A few minute on the treadmill for the man who runs miles everyday. Cakewalk.
The verdict: “Fit, no cardiac problem.”
A verdict from a specialist is special and means so much.
Mr Smith was happy. Satisfied.
But what if, what if there was a slight abnormality on the exercise ECG? Remember what happened to George W Bush? And what about the biggest modifiable risk factor for Mr Smith? Has he been falsely reassured?
Mr Smith, the running steam engine bellowing smoke on the street.
Oh, what a silly way to trouble my little brain with all these mundane worries.
Time to go home and enjoy the wine.
On the Bush story:
A blog post by Dr Richard Bogle, cardiologist on a recent paper from the COURAGE study that questions the wisdom of stenting narrowed LAD, a lesion commonly known as a “widow-maker”. Head versus Heart, Emotion versus Science
The Coronary Artery Entrapment Dr Bernard Lown reflects on how medicine has transformed from a humanitarian profession to a costly technocracy.