Heart Attack!

[doc henderson]

If you are old and have risk, like smoking, htn, high cholesterol, diabetes, you should get a stress test.  Lots of things cause costo.  anything inflammatory.

[doc henderson]

he was right, based on the pic.  he was in Mexico.  he had diarrhea.  I was happy to have a froze up AC that just needed the filters cleaned.

[doc henderson]

@metalspinner I just saw your question.  We look at risk stratification.  family history (often confounded as most men smoked back in the day), symptoms, age, other illness (high blood pressure, diabetes, high cholesterol, previous heart attack or stroke).  We can do a walking stress test, a chemical induced stress if you cannot walk well, and a combined stress test with echocardiogram.  If symptoms are significant (not all and in fact most "chest pain" is not coronary disease and a heart attack waiting to happen), we may go straight to heart cath.  If the EKG shows a st elevation MI (STEMI) go to cath.  Slight elevation in the heart enzyme Troponin, then a cath the next day, on heparin in the hospital.

[doc henderson]

Sorry Peter, just saw your question.  they had chest pain, and their EKG showed ST elevation, so they went to heart catheterization within 20 minutes.  they used to call the ST elevation that looked like rectangle "tombstones", but success is very good these days, and most folks do not die, and do recover.  The abbreviation for ST elevation myocardial infarction is STEMI.

[doc henderson]

not a heart attack.  8-year old playing football.  got him calm and able to reduce it without a lot of meds.  

[YellowHammer]

Did he score?  

[customsawyer]

I think it looks just fine. Keep in mind that I'm not a Doctor. Heck I'm not even a professor.

[Larry]

My little story.

I have copd which is being treated by a pulmonary doctor. He suggested that a heart issue could be contributing to my breathing difficulties. He referred me to a coronary doctor for assessment.

The heart doctor scheduled a batch of standard tests. I didn't do good on the stress test and a CT scan showed I had a off the chart bad calcium level. I asked what that meant and was told it was quite possible I would have a heart attack or stroke within a year. I thought not good and what should I do? Doc said a angiogram and he would probably place one or two stents to open up my arteries. Anymore it's no big deal and might be out patient or at worse a overnight stay in the hospital. Lets do it!

I arrived at the hospital early and they wheeled be into the cath lab and put me under. Couple hours later I woke and the doc came to see me. Whatcha do doc? Nothing, we only found minor blockage in one artery. Not bad enough for a stent. The super high calcium score is because it was all on the outside of my arteries. 

Doc tweaked my blood pressure medicine and said my pump was good to go. He wants me back in a couple of years for another stress test.

The bill for the angiogram was $30,000 and with the other tests the total was close to $40,000. I have an excellent Medicare advantage plan and my out of pocket was a few hundred. My pcp is a friend and we had a conversation about some tests may be prompted by a financial incentive. Just idle talk but a consideration.

[Dave Shepard]

I don't have time to adequately cover the last eight months of doctors visits and tests, but it became clear that they were taking advantage of my health insurance. Most of it was triggered because they thought I had an enlarged spleen. Eight months later "you are a big guy, so you have a large spleen". Forum rules prohibit any further discussion of this conversation. 

[doc henderson]

It is a tough business.  My several ED visits where I also work were about 20K each for 3-hour visits.  An enlarged spleen would raise concern for cancer, so I am glad they did not find that, but they do not want to miss an opportunity to catch something early.  I do not even know how to check on insurance (I can ask someone to do it).  I do less sometimes if it can wait if it will create a large bill for the patient.  I am sorry this turned out that way, but glad you have insurance to cover costs, and they did not find anything serious.