Hi all,

My husband is very concerned about his heart. Every male on his father's side of the family has died of heart attack before the age of 60 - cousins, uncles, his father - some younger than he is now. He doesn't know any more details other than heart attack (I assume there might be more information; it's just not available).

He's been telling his PCP during every visit that he wants her to check things out. She's done a stress EKG, which was fine. He has slightly high BP which he's taking medication for (it's ~124/84 with meds.) Also cholesterol controlled with meds (don't know the numbers on that.)

She will not do any further tests. She told him he's paranoid. :confused:

I'm pretty sure there are more tests available by now but I have no clue what they might be. If someone could point me in the right direction, I'd really, really appreciate it.

Thanks so much in advance!

I certainly don't think he's being paranoid with a family history like that. Plus, with medication his blood pressure should be controlled better than it is, below 120/80. With meds, I'm usually 110/70 without I was 135/88.

The next best test for your husband would be a nuclear stress test. This will show if there are any areas of his heart not getting sufficient blood during exercise or at rest which would indicate a possible blockage and impending heart attack. These tests are about 85% accurate but have a very high negative predictive value when normal. The problem he may have is that since his tests have all been normal, his insurance may not cover a nuclear stress test as they may feel his PCP has done enough to rule out any presence of CAD. Plus the PCP has to reccommend the test which they may not be willing to do, some doctors feel the tests he has already had are enough.

I'm sure that if he went to see a cardiologist they would do the test just on his family history alone as it is the most important risk factor along with smoking.

The only way to know 100% that he is CAD free is with a cath, but they will normally only do these in the presence of an abnormal nuclear stress test or with symptoms like unexplained chest pain. In addition, caths have anywhere between a 1% - 3% risk of complications.

Good Luck.

Tony

Thanks a lot, Tony.

I thought his BP was a bit high for being controlled with meds. His PCP told him it's fine though...

So far the only test he's had has been the stress test which was several years ago by now. His health ins will cover everything 100% BUT she has to order it. That's seems to be the main problem right now. I will tell him about the nuclear stress test. Maybe he'll be able to prod her a little more. I'm not a doctor (obviously! haha) but I really don't believe she should be taking this so lightly. I will tell him about the BP too.

Thanks again for the info! I had looked around but it's sometimes difficult to find good info when you don't know what you're looking for.

I don't believe you told your hubby's age. I know when I was in nursing school they taught us that 140/90 was considered hypertensive. I don't think his numbers are high myself, but that is just my opinion. I know I had a stress test about 3 years ago at age 52 that was inconclusive because I could not stay on the treadmill long enough because I have fibromyalgia and other problems, so they did a Cardiolite Stress Ekg that was normal. I had an echo in 2001 that was negative (sister & daughter have Mitral Valve Prolapse so they screened me) Anyway, I went just a couple of months ago as I was staying fatigued all the time and I had 4 incompetent heart valves. I thought wow, how could that be?

I know that although I thought that I had been screened pretty well over the last 5 years, I still showed up with a heart problem. I have always watched my diet and my cholesterol was 360 even though I eat only fish and chicken and no fried foods or dairy. I'm just telling you that even though you go for a physical and you are screened today and everything is fine, tomorrow can be another story.

If your husband is really concerned, if he complains of chest pain or shortness of breath, it would warrant further testing. I know it is hard not to dwell on the history as I am just a few months from being the age of my father when he died of heart disease. So I understand his being worried. I hope everything turns out fine. Take care.

124/84 is a decent but still pre-hypertensive blood pressure reading and that's after meds. the goal of meds should be to get the readings back under normal numbers of 120/80, which may mean they should try a different drug or it may be that 124/84 is as good as it gets.

I take Benicar HCT 40/25 which worked from the first day. You also need to understand that blood pressure rises and falls throughout the day depending on exertion and stress. Just because he is at 124/84 when he is being tested does not mean that's his average BP reading. If he is under considerable stress or exerts himself throughout the day he may be spending a large part of his day well over that number, the only way to know is a portable monitor that takes readings throughout the day to average one's BP.

If the stress test was several years ago I think the PCP is being unreasonable based on his concerns, even if there are no symptoms. I would still see a cardiologist, they'll do the test based on his history and to give him peace of mind in nothing else. He may need to be referred by his PCP though.

Good luck.

Tony

Thanks for the replies, Goldy and Tony!

First off, he's 49 now. And yes, I did some looking around for BP guidelines with meds, and according to those, his readings are fine. I still think (in my completely untrained opinion!) that it should be normal or less.

Tony -

I don't think the PCP even wants to get it lower. She seems to be happy with where it's at, and that's the end of it for her.

She did give him a BP monitor which he is horrible about using. Sometimes I just want to smack him! As worried as he is about this, he'll make sure he eats healthily, works out every day, but when it comes to medical stuff... GRR! It's almost as if he believes if he closes his eyes and doesn't do it, then it just won't be there! I'm not really sure how to deal with that.

He absolutely HAS to be referred by the PCP for any and all testing in any area. I'm tempted to go with him on his next appointment if he's ok with it. I really don't think he should mess around with this. I want to make sure I'm informed before that happens, though.


I'm just telling you that even though you go for a physical and you are screened today and everything is fine, tomorrow can be another story.

That's part of the reason I'm a bit worried. His stress test has been around 5-6 years ago now, and that has been it other than BP and cholesterol checks.

If your husband is really concerned, if he complains of chest pain or shortness of breath, it would warrant further testing.

He does sometimes say he has a weird feeling in his chest, but I haven't been able to get him to describe what it feels like exactly. From what I can tell, it's not constant and passes after a couple of minutes at most. It worries him a lot, of course, as it does me.

He's not paranoid!! My father's brothers and father all died from heart attacks, some in their thirties, one in his forties. My father's mother lived to 98. One day my father passed out in the back yard, and still would not seek help. He finally had to get an exam to renew his insurance and that's when they found 5 blockages!! He had the surgery and now is 81 years old. He wouldn't have survived had he not had the test which checks for blocked arteries.

I'm glad you're dad is doing well, refuge!! I hope I can get my husband to prod his doctor enough to check him out thoroughly before he's forced to get checked out - which may never happen...

I think I'll tell him your story. Maybe that will help! Thanks!