27 March, 2024

Questions You Asked

Here are some of the questions patients have frequently asked over the past few years.

I used to have high blood pressure (BP) before. Since I started taking medicines for it, BP is now under control. Can I stop my medicines now?
The fact that your BP got under control after you have been put on medicines, there is a very good chance your BP will go back up again after you stop the medicines. You should shift your focus from stopping the medicines to adopting a healthy lifestyle that includes optimal diet and weight, regular exercise, low salt diet etc. The need for BP medicine is dynamic and doses need to be adjusted (up or down) based on your body’s requirements. Learn more about blood pressure basics and essential aspects of hypertension management.

I have periodic chest discomfort. My ECG and echocardiogram is normal. Can I be reassured that I don’t have heart disease?
While ECG, Echo, and blood tests (e.g. Troponin) are excellent at picking up any damage to the heart muscle (when all 3 tests are combined), they can not detect blockages of the blood vessels. A normal ECG/Echo/Blood test means no damage to the heart muscle, but can not tell whether someone has blockages or not. More so, these tests tell us about the current situation and do not predict the future. Based on an individual patient’s clinical profile, further investigations may be necessary to estimate an overall risk of developing heart disease in the future. Such tests can be in the form of Stress Tests like Treadmill (TMT), Stress-echo, or advanced forms of scans like SPECT or cardiac MRI. In a few situations, coronary angiography or CT-angiography may be required.

Is it possible to get a heart attack even after a successful stent placement?
Unfortunately yes.
Stents help maintain the blood flow through heart arteries by pushing the existing blockage outwards. As we age, and with the risk factors, our body continues to form more blockages. While a stent opens a severe block at the time of need, it does nothing to prevent the body from forming further blockages. In fact, the human body identifies a stent as a foreign material and tries to form blockages over it as well. This is where medicines and lifestyle measures become essential to reduce the chances of further blockage formation. While these measures work very well, they are not 100%.

I have hypertension and even after taking multiple medications, my BP is not controlled. What should I do?
Poorly controlled BP, even when someone is taking multiple medicines, calls for root cause analysis rather than just changing medicines.
Reasons why BP may be uncontrolled even while taking multiple medicines:
Sub-optimal dosing or frequency of the medicines
Consuming more salt than recommended
Excessive weight/obesity
Obstructive sleep apnea
Poor quality medicine
Faulty BP machine giving a wrong reading
Issues related to other organs like the kidney, thyroid, and adrenal glands.
Significant psychological stress
Regular use of painkillers

I occasionally feel my heart beating very fast, but this lasts only a few seconds. I otherwise feel fine. My ECG and Echocardiogram are normal. What else should I do?
Episodic palpitations (feeling of a fast or irregular heartbeat) can be due to abnormal heart rhythm, commonly grouped as ‘arrhythmia’. This can be tricky to identify at times because, by the time an ECG/Echo is done, the symptoms and arrhythmia may have been resolved on their own. The best way to identify such issues is through prolonged continuous heart rhythm monitoring called Holter, etc. Also, thyroid function should be checked.
Sometimes, palpitations are felt in the absence of any identifiable arrhythmia. In such situations, medicines are not required.

What is the difference between angiography and angioplasty?
A detailed description of this topic can be found here.

I just got tests done last month. Why do I need to repeat it?
There are many reasons to repeat a test. I will list a few:

1. To evaluate a new problem: If the doctor suspects a recent change in your body’s condition, based on your symptoms, physical examination, test reports, or due to medication effect. If a new problem started AFTER the older test reports, it would be wrong to assume that a test result obtained previously will still be the same.
2. To see a trend: Sometimes, values are outside the normal range for a particular person, and the physician may want to examine whether the condition is getting worse or better.
3. To compare from previous: Particularly for image-based tests like X-ray, ultrasound etc. Comparison is the basic essence of clinical medicine. The whole idea of evaluating somebody is to compare it to normal.
4. Discrepancy: Sometimes clinical suspicion and test results don’t match. In this case, the doctor may ask to repeat the test to ensure it’s not an error or a matter of chance.
5. Variability: The quality of certain tests, such as ultrasound, echocardiogram, biopsies, and angiography, relies heavily on the expertise of the person performing them. To be confident about a result, doctors sometimes like to have the test repeated by someone they consider an expert at it.
6. Additional information: Sometimes, a test is done as an initial investigation and needs to be followed up with a dedicated second test to get additional information. For example: a CT scan of the abdomen may reveal some liver abnormality. A repeat CT with a focused liver protocol may be needed to evaluate the abnormality more precisely.

I have a scheduled appointment with a cardiologist. Should I bother to bring my endoscopy report as well?
Yes. As a general rule, please bring all your previous papers, including your current and old medicines. A doctor may or may not review those at his/her discretion but having the information handy is very important. Also, if you have images/CDs of previous tests/procedures, those are very helpful as well.

I want to know more information about my doctor. How do I find out about it?
The best way is to ask him/her directly. Here are some of the questions which are fair to ask your doctor in a non-critical manner:
When and where did you get your medical education?
For how many years you have been practising?
How many procedures have you done so far? (This is relevant only for the procedure the doctor plans on doing to you or your loved one)
How many similar patients have you treated before?

Unfair questions to be asked would be:
Which is your hometown?
What are your religion/caste/political beliefs?

I was diagnosed with blockages of my heart arteries (Coronary Artery Disease). Which medicines should I take to get rid of the blockages?
Unfortunately, our body has no systematic mechanism to ‘remove’ blockages from the arteries. Medicines are given to slow down the further worsening of the blockages or to change their configuration to make them less dangerous. Medicines and physical exercise induce conformational change to blockages, making them more stable. Such blockages, even with the same degree of narrowing, are much less likely to cause a heart attack. It is almost impossible for medications to eliminate the blockages.

My doctor has prescribed a brand-name medicine. Am I supposed to take that particular brand only?
No. Doctors write brand names for ease of writing and personal experience/trust in the brand. You are under no compulsion to take that particular brand. Each brand-name medicine mentions the chemical composition (called Active Pharmaceutical Ingredient – API). You can choose any other brand with the same API and at the same dosage. Unfortunately, the clinical efficacy data of most of the brands available in the market is not readily available. Hence, it is impossible to establish one brand’s superiority over the other. While at it, I should also mention that it is fair to substitute the written prescription with the medicines available at Jan Aushadhi Kendra or govt dispensaries provided the API content and dosage are the same.

My friend had a heart attack at age 50. He doesn’t smoke or drink, is a vegetarian, and does daily exercise. How did this happen?
Coronary artery disease and heart attacks happen due to various factors; a lot of which are still unknown to the scientific community. Among the known factors, many are non-modifiable and define who we are. It has to do with genetics and ethnicity among others. Also, external factors like stress, pollution, and lack of nutritious food play their part. Many times, high cholesterol, diabetes or similar illnesses go unnoticed due to a lack of routine checkups.

Feel free to message me with your queries; I will happily answer them.

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