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Heart Health FAQ: Stress Tests, Heart Attack Risk

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FAQ on Stress Tests

(Answers provided by Dr. Enrique Velasquez of The Heart Center in Huntsville)

Q: Who should have a stress test?

A: Not all patients may need the same test. There are some patients in which a stress test is the most appropriate test, but in others the test may be insufficient or not helpful. Only your doctor can decide which test is best for you.

Q: I don’t have any symptoms or heart problems. Should I have a stress test just to check to see if I have blockages?

A: The answer in most cases is “NO”. The American College of Cardiology and the American Heart Association DO NOT recommend doing a stress test in asymptomatic patients with low risk of coronary disease. There are other tests that can be used for “screening” for coronary disease. These screening tests, however, are usually not covered by insurance.

Q: What is “positive” family history of heart disease?

A: A family history of heart disease is defined by a 1st degree relative with sudden cardiac death, a heart attack, or being diagnosed with coronary disease (blockages) under age 55 for males and under 65 for females. This means that if your grandfather had a pacemaker at age 80, your uncle had a heart attack at 70, or your cousin died at 65 from a stroke you DO NOT have a strong family history. A patient whose mother had a heart attack at age 64 and whose father and brother both had stents at age 50 however, is at increased risk.

Q: How can I estimate my risk for having heart disease?

A: There are several formulas for determining your risk for coronary disease and having a heart attack. The most widely used one is called the Framingham Risk Score. This calculates the 10-year risk of developing a cardiac event. A 10-year risk of 20% or more is considered high. Several websites including The American College of Cardiology, the American Heart Association, and the National Heart, Lung, and Blood Institute offer risk calculator tools.

Q: My doctor wants to start me on cholesterol medicine but my cholesterol is not that high. Do I need to take this?

A: The cholesterol medicines known as “statins” have other beneficial effects on the heart other than just lowering your cholesterol number. There are countless studies showing a decreased number of heart attacks, slowing the progression of blockages, and reducing the need for stents in patients who have been diagnosed with coronary disease.

Q: My doctor prescribed me a “blood pressure medicine” but my blood pressure is fine.

A: Several medicines are used after a heart attack to help the heart heal and recover its function. These medicines are also used for high blood pressure, but your doctor may be prescribing them to improve your heart function and not for blood pressure.

Q: How much aspirin should I take?

A: If you have been diagnosed with coronary disease or had a heart attack in the past then 81 mgs (baby aspirin) is all you need. The full dose of aspirin is typically used in the acute phase of a heart attack while in the hospital. Also, if you are taking the medication called Brilinta you should NOT take more than a baby aspirin or it could adversely counteract the effect of Brilinta.

Q: My neighbor had a heart attack and had two stents placed, but when I had my cardiac cath my doctor did not use a stent. What is a stent?

A: All patients that undergo a procedure called “angioplasty” have some form of blockage fixed by opening or “cleaning” the inside of the artery with a small balloon attached to the catheter. This is what “breaks up” the blockage and gets rid of the obstruction. A stent is a small metal “mesh” used to cover the area that was opened up with the balloon. The use of stents have improved the results of angioplasty, but not all blockages will need a stent. Also, if the artery is too small or too “hardened” from calcium a stent may not fit.

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