By Dianne Gebhardt-French
SmartHealthToday
Medicine is the art of interpreting each piece of the puzzle and the science of knowing what to do with the answers.
For cardiologist Dr. Mohanjit Brar, each patient is a rich combination of lifestyle, risk factors and family history. When a patient receives the right tests at the right time, he can receive care that can improve, and even save his life.
Not only are the tests developing but “I think our understanding as to how we should use these tests is improving,” said Brar of St. Elizabeth Healthcare Heart & Vascular Institute.
“As people grow older, and they are in their 40s and 50s – especially in their 50s – you can focus on the numbers for a starting place,” said Brar. The numbers being blood pressure, blood sugar and cholesterol.
From there, based on risk factors, there are more tests available aimed at prevention.
For a select few, a category of people with a strong family history for heart disease, a closer look at their cholesterol may be merited. A test can examine the size of particles, because “sticky” particles are smaller and denser. They attach to blood vessels more easily and cause inflammation and other problems. For those patients, the test “may be more relevant” in preventing heart disease, explained Brar.
Also available is the coronary calcium scan, it’s a noninvasive CT that involves no injection of dye. It allows the doctor to check for calcium buildup and blockages in the three major heart arteries. The patient may not have any symptoms, so it is a valuable prevention tool.
Another test that can be useful is the C-reactive protein test (CRP) for inflammation. It is “not a test for all comers,” he explained, just patients with multiple risk factors (including a high calcium score, family history and being pre-diabetic.) It’s “a very good test that can predict events in people who are more likely to have a heart attack,” said Brar, who can then be treated more aggressively through medication. But a test like this can have a false positive because arthritis or infection can cause an inflammation. “So you can repeat it a couple of times, looking for infection and trauma and anything else going on,” said Brar.
“You can get screening tests, you can have blockages and never have a heart attack…Some get a heart attack without warning,” he said, stressing that tests are tools and not the final answer.
If a patient already has heart disease, already had a heart attack or has chest pain or shortness of breath, Brar uses diagnostic tests. The echo stress test, for example, looks at heart function on the treadmill, and he can compare the heart rate at rest and with physical stress. It’s not offered to patients who are exhibiting no symptoms.
“You are hearing all the time that someone had a stress test but still had a heart attack three or four or six months down the road,” because they had a blockage that didn’t cause problems during physical exertion.
How do doctors stay on top of the new technology and advances?
“That’s a good question,” said Brar. He says that’s why St. Elizabeth and other major health groups encourage physicians to be board certified.
“The medicine changes enough every 7-8 years; you have to refresh yourself or otherwise you’ll be left behind.”
Being board certified “keeps us in the loop and keeps us abreast of the technology,” said Brar, who is board certified both in interventional cardiology and cardiovascular disease.
Also, he added, you learn a lot from your peers.
SmartHealthToday is a service of St. Elizabeth Healthcare.