‘Calcium scoring, CT angiography best tests for cardiac diseases’

Family physicians have an immense responsibility to identify heart diseases at an early stage and also diagnose the symptoms within the golden hour, said chief cardiologist and managing director of the Ramesh Group of Hospitals Dr.P. Ramesh Babu.

Speaking to
The Hindu
, on the sidelines of a day-long Continuing Medical Education (CME) series: ‘We are at par in Advanced Medicare’, organised by the Tirupati branch of the Indian Medical Association, in association with the Dr. Ramesh Health and Education Society, Vijayawada and Ramesh Hospitals Group, here on Sunday, Dr. Ramesh Babu opined that family physicians have been missing out on two major opportunities – identification of heart diseases 10-15 years before its incidence and arriving at an accurate diagnosis in case of such incidence, well within the golden hour. “Despite the advancements made in the past few decades, the incidents of sudden cardiac death have not been prevented.

As many people rely on family physicians on treating their hypertension and diabetes, the former have an important role to play in spotting the disease early and preventing sudden cardiac deaths, despite patients being asymptomatic,” he said. ‘Calcium Score of Heart and CT Coronary Angiogram’, a 15-year warranty test, would calculate the risk of developing coronary heart disease more accurately than the regular investigations such as ECG, Echo and Treadmill. “For example, if a 45-year-old person undergoes the test and gets a normal score, there is 99% chance that he/she will not have a heart attack in another 15 years. It is even included as the first line of investigation under the National Institute for Care and Excellence (CARE), London,” he remarked. Further elucidating on the risk factors, genetic predisposition in Indian patients and other issues, Dr. Ramesh Babu He said that 95% of the heart attacks are mistaken for gastric trouble and stressed on the need for proper diagnosis. “Besides this, 30% of the incidents are silent heart attacks and one should understand that breathlessness, as a recurring problem, needs immediate attention. It is dangerous than chest pain as 25% of the heart should be damaged to cause breathlessness, whereas 5% of heart muscle damage is enough to cause heart attack. Hence, people should not ignore it,” he added.

Assessment of blocks

Dr. Ramesh Babu also outlined on investigations to identify the hemodynamic significance of a block via Fractional Flow Reserve (FFR) and Instantaneous Flow Reserve (IFR) to accurately assess the degree of stenosis and check the flow, as it would clear the confusions between bypass surgery, balloon angioplasty stenting, advanced medication, diet and yoga.

In addition to this, Cardiac MRI will also show the extent of damage, micro vascular obstructions and thickness of scar. “It has been indicated that four out of 10 times, eyeballing can be wrong in assessing the degree of stenosis/percentage of block etc. Utilising these procedures can prevent unnecessary stenting, surgery and rectify the errors of not advising appropriately,” he opined.

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