Last Update: Wednesday, July 23, 2014

LIFELONG HEALTH- Unnecessary Testing Harmful, Boosts Costs PDF Print E-mail
Written by Dr. David Lipschitz, Creative Syndicate   
Thursday, 08 March 2012 03:06

Frequently, I see asymptomatic patients who report a "clean bill of health" from their cardiologists. Their electrocardiogram, stress test, echocar-diogram and CT scan of the heart are normal.

Occasionally, these patients are being screened because they have a known coronary artery disease. But quite frequently, they are middle aged or older and are being screened to assure no problem exists. With these patients, the tests had no value and the cost was high.

So what are these tests and when should they be done? An electrocardiogram, or EKG, measures the electrical activity of the heart. With each heartbeat, an electrical current begins in the top of the heart and moves down a conduction system stimulating the heart to contract. Electrodes placed on the chest and arm read out this electrical activity. The pattern of the readout can detect a new heart attack, evidence of an old one and irregularities of the heartbeat.

It is an invaluable diagnostic tool for someone who has symptoms suggestive of a heart attack or to diagnose conditions such as atrial fibrillation in which gross irregularities of the heart rate can lead to an increased risk of strokes and heart failure. However, as a screening test, an EKG has virtually no value. It may miss heart problems and just as frequently, may show changes suggesting heart disease that is not present.

A stress test involves stimulating the heart to beat faster either by exercise using a treadmill or by mimicking the effect of exercise with the injection of a medication (persantine) and a radioactive marker that can identify areas of inadequate blood supply. This test remains a "gold standard" to diagnose coronary artery disease in someone with chest pain or shortness of breath. However, no study has shown the test to be of value as a screen for coronary artery disease in a healthy, asymptomatic person.

An echocar-diogram is a test that allows a complete evaluation of the four chambers of the heart and the way in which the heart contracts with each heartbeat. It measures the amount of blood that is pumped out of the heart with each beat and can evaluate the function of the heart valves between the chambers of the heart and pulmonary and aortic arteries. This noninvasive procedure can identify severe weakness or dysfunction in the way the heart muscle contracts, as well as diagnose problems with the heart valves. This test should never be used as a screening test in normal individuals.

Of all the screening tests, the cardiac CT scan is the most problematic. Used as a marketing tool, this test promises unwary consumers the potential of saving lives by performing this "heart saving" CT scan. Coronary artery disease is suspected if increased calcium in the arteries is noted. Combining a CT scan with the injection of a dye can demonstrate significant blockages of coronary arteries.

In chronically or severely ill individuals, a cardiologist may prefer a less invasive CT scan to an angiogram to diagnose coronary artery disease. The scan provides a great deal of irradiation and is of no proven value as a screening test. Particularly egregious is the use of a CT scan to screen for heart disease in anyone over the age of 70. At this age and beyond, the narrowing of the coronary arteries is very common. By identifying excessive calcium, additional evaluations including angiograms, angioplasty and even open-heart surgery may be done. The patient may believe that a heart attack will be prevented and life prolonged. Unfortunately, invasive procedures do neither. Though they do relieve symptoms, which these patients do not have.

Prevention is the key to managing heart disease. It is all about diet, exercise, stress reduction and control of blood pressure and cholesterol. As for me, 16 years ago I had a heart attack. Since then, I have never had an EKG, stress test or echocar-diogram. Even with known heart disease, these tests are only needed if new symptoms such as chest pain, palpitations or shortness of breath occur. Understand that unnecessary screening tests do more harm than good, and their cost is contributing to the collapse of our health care system.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging."


Team members care for thousands of the region's sickest children with heart conditions, including fetuses, newborns, infants, children, adolescents, and adult, long-term patients with pediatric cardiovascular conditions. At Children's families experience coordinated, next-generation care, delivered by a compassionate, multidisciplinary team of leaders in the pediatric cardiology field. One of the largest pediatric cardiovascular programs in the region. Studies have shown that high volumes are associated with high quality and better outcomes, because experience is a major factor in quality of care. Wort was traditionally prescribed in parts of Europe for depression (in addition to use as a general-purpose tea), and Chinese medicine developed elaborate lists of herbs and preparations. With the scientific revolution in Europe and the United States, the use of traditional herbal remedies fell out of favor with the mainstream medical establishment, although a few people continued to use and maintain knowledge of traditional European herblore. In the early 20th century, scientists began reassessing this rejection of traditional herbs in medicine. Vorzüge eines intakten und lebendigen Gemeinschaftslebens bewahren. Dafür sorgen nicht zuletzt gut 120 lokale Vereine. Als wichtiger Faktor im Kulturleben haben sich die zahlreichen Museen und einige Kunstgalerien erwiesen. Descriptive and quantitative transcriptome analyses are important for interpreting the functional elements of the genome and revealing the molecular constituents of cells and tissues. It is known that sperm function can be affected by ASG proteins, including the processes of capacitation and the acrosome reaction, as well as canadian pharmacy accutane sperm motility, DNA integrity and interaction with the oocyte. BSPs (bovine seminal plasma protein, unigene 64,588 and unigene 69,768), fertilin (unigene 17,270 and unigene 27,136), ACE (Angiotensin converting enzyme, unigene 7,164 and unigene 21,069), GPX5 (glutathione peroxidase, epididymal secretory glutathione peroxidase, unigene15860), Spermadhesin-1 (Acidic seminal fluid protein, aSFP). The reproduction-related transcripts identified in the ASG and testis transcritptomes in E. This interaction of PDC-109 with the sperm cell membrane results in an efflux of cholesterol and choline phospholipids, that appears to be important for capacitation. The main changes in spermatozoa that occur during epididymal maturation are the ability to move, recognize and bind to the ZP, and to fuse with the plasma membrane of the oocyte.. Oct 2004, Adelaide, Australia. Ziaian T, Augostinos, M. Relationship Between Acculturation and Mental Well-being Among Young Persian Women Living in Australia. Paper presented at the Educational Research conference, 18th November 2004, Adelaide, Australia. Ziaian T, Stress Management: an introduction of holistic coping strategies. A Four day Course for the higher degree students. Targeted molecular therapy for advanced epithelial ovarian cancer. Minimally invasive surgery for gynecological cancer. Pharmaceutical Sciences from Shizuoka College of Pharmacy (1976, Japan). He has completed his B. Prophylactic removal of nevi without clinically worrisome characteristics is not recommended. The reasons for this are practical: many individuals in these families have a large number of nevi, and complete removal of them all is not feasible, since new atypical nevi continue to develop. In addition, individuals with increased susceptibility to melanoma may have cancer arise de novo, without a precursor lesion such as a nevus. The disadvantages of screening include the limitations of available noninvasive testing methods and the risks associated with invasive screening procedures. ERCP is the gold standard for identifying early cancers and precancerous lesions in the pancreas..