Medical Tests & Procedures Archive

A study questioned the benefit of stents for some heart patients. What does this mean for people with chest pain?

Last fall, many news outlets highlighted a study suggesting that a common heart procedure — inserting a stent to open a narrowed heart artery — was no better than a sham procedure (see "Stent vs. sham: A short summary"). But the big picture isn't quite so simple.

For instance, it's worth noting that six weeks prior to undergoing the procedures, all of the 200 people who completed the study were prescribed increasing doses of heart medications. Referred to as optimal medical therapy, this approach is a proven strategy for treating chest pain brought on by physical activity or emotional stress that promptly goes away with rest or nitroglycerin (so-called stable angina).

Dozens of clinics offer unproven stem cell therapies for heart failure. Despite steady progress, this experimental treatment is not ready for prime time.

 Illustration: Scott Leighton

A heart attack cuts off blood flow to part of the heart's muscle, usually causing lasting damage. Over time — especially in people with repeat heart attacks — the resulting scar tissue can hinder the heart's ability to function normally, leading to heart failure.

For nearly two decades, scientists have studied how stem cells might repair a damaged heart and restore its function. These unique cells, which have the potential to grow into a variety of heart cell types, can be made from other cells (see "What's new in cardiac regeneration?").

Precision medicine offers a personalized approach for prevention and treatment of cancer and other diseases.

 Image: © Pogotskiy/Thinkstock

If you have a stomachache or cold, you go to the pharmacy and grab the same remedy that everyone else uses, and it often works. But is that always the best approach? Your reaction to an infection may be quite different from someone else's, so perhaps you need a treatment designed just for you and your ailment.

That's the philosophy behind precision medicine (sometimes referred to as personalized medicine), an emerging approach to prevention and treatment that takes into account a person's genes, environment, and lifestyle and eliminates the one-size-fits-all approach to health care.

In the journals

Magnetic resonance imaging (MRI) has long been considered dangerous for people who have electronic heart devices like pacemakers and defibrillators implanted in their bodies. Now, a study published online Aug. 14, 2017, by the Journal of Clinical Electrophysiology suggests the scans are safe for most people with these devices.

Until recently, most devices were not FDA-approved for MRI. They had been considered risky because it was feared that the high-strength magnetic fields used for the scanning could disrupt a pacemaker's or defibrillator's circuits. Yet, when researchers reviewed 212 MRI examinations involving 178 patients with these nonapproved devices, they did not find a single problem with how they functioned. The researchers concluded that MRI is safe for someone with a device implanted after 2000, as long as the device is checked before and after the procedure and its pacing function is monitored during the scan.

Research we're watching

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A new test might help doctors better treat patients with urinary tract infections, according to a study published in the Oct. 4, 2017, issue of Science Translational Medicine. These infections prompt some eight million doctor visits each year, and doctors often prescribe antibiotics to treat the condition. However, sometimes the bacteria they are attempting to treat are resistant to first-line antibiotics. The delay caused by the ineffective medication can, in some cases, cause the patient's condition to worsen and lead to complications. To eliminate this antibiotic guesswork, researchers developed a new quick-acting antimicrobial susceptibility test that not only tells the doctor within 30 minutes whether the patient has a urinary tract infection, but also what type of bacteria caused it and what drugs will best treat it. The test can also quickly identify cases where antibiotics aren't needed at all, preventing overuse of antibiotics, which can promote resistance. The same type of rapid testing, might eventually be of use in identifying the best anti-biotics for other types of bacterial infections as well.

In the journals

A study published in the September 2017 issue of JAMA Internal Medicine found that doctors may prescribe an electrocardiogram (ECG) as part of an annual health examination even for people at low risk for heart disease. The study looked at about 3.6 million people with no history of heart problems, like heart attack, high blood pressure, or diabetes, who had at least one routine exam over a five-year period. Of these people, 21.5% had an ECG within 30 days after their exam.

The researchers found that those who got the ECG were five times more likely to get further cardiology testing that not only increased out-of-pocket costs, but also raised their risks of radiation exposure and complications from additional procedures. The addition of an ECG did not appear to offer additional benefits, as the rates of death, heart-related hospitalizations, and bypass surgery were equally low in both the ECG and non-ECG groups at the one-year follow-up.

These devices help you keep tabs on a key indicator of your cardiovascular health.

Of all the things you measure to assess your health, blood pressure certainly ranks among the most important. High blood pressure not only puts you at risk for a heart attack or a stroke, but also can damage your brain, eyes, and kidneys.

For some people with this common condition, checking blood pressure intermittently at the doctor's office may not be enough. Investing in a simple, inexpensive home blood pressure monitor often makes sense. It's especially helpful when you're starting a new medication or are taking several different ones and still working to reach your blood pressure goal.

Screening for lung and breast cancer may reveal information about the health of your heart's arteries.

 Image: © Jupiterimages/Thinkstock

Screening tests for two of the most common forms of cancer involve detailed x-ray images of the chest. Growing evidence suggests that these tests — chest computed tomography (CT) scans and mammograms — may also offer clues about a person's risk of heart disease.

"Both doctors and their patients should be aware that the low-dose CT scans used to find lung cancer can also detect plaque in the arteries of the heart," says Dr. Ron Blankstein, a cardiovascular imaging specialist and preventive cardiologist at Harvard-affiliated Brigham and Women's Hospital. CT scans take a series of rapid-fire x-rays in seconds. Combined, the images allow doctors to "see" structures inside the body.

In most cases, a primary care doctor or chiropractor can help you resolve the problem.

Low back pain is one of the most common complaints on the planet. And you may wonder where to turn when you start experiencing some of those aches or twinges in the lower part of your back. Take heart. "In most cases, you won't need a specialist," says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center.

When pain strikes

There are many causes of low back pain. Some of the most common include an injury to a muscle or tendon (a strain), an injury to a back ligament (a sprain), and a herniated or "slipped" disc (when the soft material inside of a disc between spinal bones leaks and irritates nerves). Many of these issues will eventually resolve on their own.

Ask the doctor

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Q. I heard my cardiologist say to another doctor that I have a "full metal jacket." What does that mean?

A. Cardiologists use the term "full metal jacket" to refer to a long series of stents in one of the heart's three major arteries. Stents are tiny metal cylinders, often with drug coatings, that help prop open arteries to restore blood flow to the heart. They're placed inside arteries during an angioplasty, in which a doctor snakes a thin, flexible tube (catheter) through the blood vessels to a narrowed section. A deflated balloon at the tip of the catheter then inflates, pushing fatty plaque against the artery wall and expanding the stent.