Check it outUp early with a fun day ahead of me. Before having lunch with the folks from the office in which I used to practice, I am meeting my old partner at the Heart Hospital for a stress test. It is just a check to be sure I don't have silent ischemia.

At the risk of turning this into a medical advise column, let me tell you that as high as 40% of people with significant coronary blockage do not feel angina when their hearts are not getting adequate blood. This is especially true for diabetics (who are like everyone else, only more so...but I digress). As a diagnostic tool, the stress test is otherwise pretty useless (unless you are at risk) since the degree of blockage in a coronary artery is no predictor for getting a heart attack.

As it turns out, it is the quality of the blockage, that is, how likely it is to rupture, cause a clot and bring on a heart attack that determines when youwill grasp your chest and slam your face into the floor. Evaluation and treatment of this gets into cholesterol fractions and particle sizes, an area in which I enjoyed great preventative success. Now to the point.

Although this knowledge is fairlly well worked out and has been around for awhile, it is sorely under utilized...even by many cardiologists. You see, during those "successful" years in preventive cardiology, I made about $0.00 since I spent too much time with patients and never got paid enough to cover overhead. So, we continue to spend tens of thousands of dollars on angioplasties and bypasses (and say we saved a life), putting out fires that could have been prevented.

(Going on a rant...a service of this blog...and you never know what it will be about)

Paddle safe...
DS

Check it out