Do Patients Really Require A SE Test For Them To Know If They Have Coronary Heart Disease?

Do Patients Really Require A SE Test For Them To Know If They Have Coronary Heart Disease?

By: Mobeen FarooqMentor: Dr. Norman A. CaginHPHS

Terminology

CAD(CHD)- Stand for coronary artery disease andcoronary heart disease. CAD occurs when thearteries that supply blood to the heart muscle (thecoronary arteries) become hardened and narrowed.The arteries harden and narrow due to the build up ofmaterials like plaque and fatty streaks in their intima.Fatty Streaks- Are the first visible lesions in the first stages of atherosclerosis. They appear in the luminal of the artery and are a yellowish in color.Fibrous Plaque- The building of fatty depositswithin the intima of the arteries. Fibrousplaque is known to be a more severe type of lesion.

Terminology Continued

Typical Chest Pain- Typical chest pain means

that pressure, squeezing or dull ache is being

felt in the center of the chest (relating to

the heart) that is usually brought on with

exertion and relieved with rest. Pain may radiate in

the neck, jaw, arms, and the upper back. It also may

appear randomly in one of these areas without any chest

pain being felt. The pain lasts for at least 30 seconds and is

relieved by rest that lasts for at least 5 minutes. However,

this is not the case if the patient is having a heart

attack in which the pain lasts for several hours.

Terminology Continued

Atypical Chest Pain- Atypical chest pain

usually occurs at rest and lasts for less than 30

seconds or more than 20 minutes and is often

recurrent. The pain maybe changed by taking

deep breaths, shifting positions, or exercise. In atypical

chest pain, the pain is tender and can be physically

felt. This is not the case in typical chest pain.

SE Test- Stands for Stress/Exercise Echocardiogram.

This test helps the doctor evaluate the patient's cardiac

condition.

Terminology Continued

Abnormal Test- Abnormalities are induced by exertion.

Normal Test- No exercise induced exertion occurs.

Atherosclerosis- Process in which the inner lining of

the intima deteriorates.

Myocardial Infarction- Medical name for heart attack.

Angina Pectoris- Chest Pain from coronary artery disease.

Background

The heart is one of the most important and complex

organs in our bodies. The main function of the

heart is to pump oxygen and nutrition-rich blood

to the cells in the body. Thus, It is very important

for each individual to keep their hearts healthy

through an effective diet and exercise. However,

there is a likelihood that more than 50% of the

population will be affected by heart disease.

The most common cardiac disease is coronary

artery disease (CAD).

Background Continued

• What is CAD? Coronary artery disease (CAD) is the most common type of heart disease. It currently affects about 7 million Americans. As we stated earlier, CAD occurs when the heart muscle is partly, if not completely cut off from oxygen and nutritional rich blood because the coronary arteries (arteries that supply the heart) become to narrow or clogged due to the build up of plaque and other such materials. If CAD is unnoticed and/or untreated, there is a greater chance for a myocardial infarction.

Because this disease is so deadly and affects so manypeople, researchers have created new methods to help better detect and treat coronary artery disease.

In-Depth Analysis of a CAD attack

Coronary Artery Disease- Click Here

Copyright © 2000-2006 HealthCentersOnline, Inc.

Background Continued

One of these methods is known as the SE test.

Basically, a SE test lets the doctor know if the

patients heart walls, valves, ventricles, atriums and

arteries are all working properly.

The SE test is a very important tool in the field of

cardiology and sometimes may help save some ones

life.

But wait…

Our project is on why a patient may NOT require a SE

Test!

Background Continued

Pros of the SE test:

95% reliable.

Gives important patient information.

Results are known soon after the test is taken.

Cons of the SE test:

A very tedious task.

For each patient the insurance companies

must pay a high fee.

5% inaccurate.

Introduction

“Doc.. I got some pain right in the middle of mychest when I walk and goes away after I rest fortwo minutes… Do I have CAD?”

When some primary care doctors hear this, theywill unambiguously tell their patients to go see acardiologist fearing that the pain might be asign of CAD. About 50+% of the primary care doctorswill not even consider if a patient has typical or atypicalchest pain or any of the other risk factors for CAD.

• We believe that this is where the problem lies.

Introduction Continued

By the end of our presentation we hope to prove the following

things:

• A SE test is not always required.• Some primary care doctors need to Scrutinize their patients

more.• A lot of time and money will be saved if the number of SE

tests are reduced.• That time and money could be used for finding a reliable

cure for coronary heart disease.

HYPOTHESIS

WE BELIEVE THAT IF PRIMARY

CARE DOCTORS WOULD BE MORE

THOROUGH IN EVALUATING THEIR

PATIENTS THEN THERE WILL BE NO

NEED FOR A SE TEST. THIS WOULD

NOT ONLY SAVE TIME BUT WOULD

ALSO SAVE MONEY!

Methodology/Materials

My mentor and I will go over the data charts of each

patient who took the SE test in the year 2002 and record

their name, age, sex, height, weight, telephone number,

family History, history of CAD, menopause (females),

diabetes, cholesterol, blood pressure, smoking, and their

primary care doctor’s name.

As of now I have the charts of 217 patients but more

charts might be needed for better data evaluation.

Methodology/Materials Continued

This is where I had to go look for the patients

charts.

Methodology/Materials Continued

After retrieving the charts, my mentor and I would go over

each patients data so that I could record more specific

Information on them.

Methodology/Materials Continued

After collecting most of the data we made a

alphabetized flow sheet to make our data neat

and organized.

Sample:

Methodology/Materials Continued

• The likelihood of CAD increases as the number of factors increase.

Coronary Artery Disease

Family HistoryFor CAD

History Of CAD Age

Bad Cholesterol level Bad Blood Pressure levelDiabetes

Smoking Sex

Female PM*Obesity

Results

For our results section, we made various tables and

charts to try to see if a pattern took place in any of the risk

factor categories. We also wanted to see if our initial

hypothesis was correct.

Results Continued

Age Group Total *CAD *NO CAD Percentage positive for CAD

20-30 1 0 1 0%

30-40 10 0 10 0%

40-50 37 1 36 3%

50-60 65 4 61 6%

60-70 67 16 51 24%

70-80 33 2 31 6%

80-90 4 3 1 75%

Results Continued

Characteristic Total CAD* NO CAD* P value

(n = 217) (n = 35) (n = 182)

Male gender 148 23 125

Female gender 18 1 17

Female gender (PM*) 51 4 47

Family History Positive 45 5 40

History of CAD positive 27 17 10

Diabetes Positive 28 5 23

Smoking 35 7 28

High Cholesterol 106 18 88

Reason For SE test

Abnormal ECG 4 0 4

CAD 74 6 68

Chest Pain 56 5 51

Typical 2 1 1

Atypical 7 0 7

Dyspnea 51 12 39

Exercise Safety 9 1 8

Palpitations 4 2 2

Takayasu’s Disease 1 0 1

Results Continued

Total CAD No CAD

Typical chest pain with 0 to 1 risk factor

14 7 7

Typical chest pain with 2 risk factors

7 4 3

Typical chest pain with 3 or more risk factors

0 0 0

Total 21 11 10

Total CAD No CAD

Atypical chest pain with 0 to 1 risk factor

45 0 45

Atypical chest pain with 2 risk factors

5 0 5

Atypical chest pain with 3 or more risk factors

1 0 1

Total 51 0 51

Results Continued

As shown by the previous slides, many patterns took shape.Out of 51 patients, 0 patients had CAD. Included in this number are those patients who had 2 to 3 or more risk factors with their atypical chest pain. Thus, according to our study, if a patient reports atypical chest pain, there is a 99.9% chance that

they will not have CAD!. To expand on this, we recommend that the primary care doctors pay close attention to elderly male patients, since they showed to be the number one target of CAD.

Lastly, it seems that the SE test is in fact NOT really required.We say this because we have proven that patients who had atypical chest pain did not have CAD. We are confident that this pattern will still prevail as the number of atypical chest pain patients increases.

Discussion

Our initial belief was that the primary care doctors were at

fault for not diagnosing their patients thorough enough. This

lead to more Se tests being done. We also believed that

the more risk factors a patient had the more likely it was

for them to have CAD.• The latter was proven inaccurate by our results.

• We have proved that some primary care doctors may not be

able to diagnose all patients for CAD. But, we have also

proved that this is not the case with the patients who have

atypical chest pain.

Discussion Continued

The results of this study do not mean that now some primary care doctors can send all non atypical chest pain patientsstraight to the local cardiologist for a SE test. We still expectthe primary care doctors to scrutinize their patients. It isvery important to remember that the SE test is not free!

• Please keep in mind that this study was retrospective.This means that all the data was gathered previously and the experiment took place some time after that. It is very important to note that the best study a scientist can do is the one that involves data being gathered from the present or the future. This way your results are very accurate and up to date!

Discussion Continued

Finally, I would like to talk to you about an article that my mentor found last week while browsing the internet. This article is very relevant to our own. “Heart diseases screenings are urged” All men ages 45-75 and women 55-75 should be tested, saysphysicians task force.

Since the SE test is one of the methods used to screenheart diseases, we believe that our results should offer some valuable information which might either agree ordisagree with the recommendation that is being offered.

Discussion Continued

Because the majority of atypical chest pain patients had normal tests, this lead us to believe thatthe physicians task force was incorrect in their recommendation. “All men ages 45-75 and women 55-75” Is a much too broad and blatant statement. More emphasis should have been given on who should really be tested. Perhaps if the prevalent CAD risk factors were somehow tied into the age groups, then the recommendation might have made more sense.I would like to end my discussion section with this quote from the “Heart diseases screenings are urged” article. I believe this is the statement that most accurately answers the proposal made by the physicians task force.Dr. Elaine Moen, “How the tests are paid for most likely will determine whether the task force’s recommendation flies.”

Conclusion

In conclusion, what we hope to prove, we proved. The SE test

is something that CAN be avoided if enough time is given to

analyze the CAD risk factors the patient has. Primary care

doctors should be extra careful with patients who display

typical chest pain and those who are elder males. They should

also take their time with each and every patient. By doing this

they can better decide if a patient deserves a SE test.

We would like to finish our presentation by saying that if

someone wants to take a SE test, than they can go ahead and

do so. This study was not made to suppress the number of

people who took the SE test but was instead made to inform

everyone about CAD and how one could avoid the SE test.

Future Study

We plan on collecting more data on patients who took the SE

test in the year 2002 to see if any changes in our results

occurs.

References

Dipan J. Shah, *Igor Klem, John F. Heitner, Michael H. Sketch,

Robert M. Judd, Victor Behar (2006). Improved Detection of

Coronary Artery Disease by Stress Perfusion Cardiovascular

Magnetic Resonance With the Use of Delayed Enhancement

Infarction Imaging. In Journal of American College of

Cardiology, Vol. 47, pp. 1622-1629.

Hurst Willis J., Rackley Charles E., Sonhenblick Edmund

H.(1990). The Heart, seventh edition. In Chapters 47-51,

pp. 893-1001.

Rudavsky, Shari (2006). Heart disease screenings are

urged. Indystar.com. Retrieved July 28, 2006, from

http://www.indystar.com/apps/pbcs.dll/article?AID=2006710/N

EWS01/607100399

Acknowledgements

Dr. Norman A. Cagin Dr. Mohamedeen

Mrs. Cagin Dr. Sat Bhattacharya

Staff at Dr. Cagin’s office Harlem Children Society

THANK YOU!

Gracias!

Shaukriya!

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Merci beaucoup! 

Grazie mille!

doh je!

Spaseebo!

Danke schön!