Medical Help Desk - Your Online Family Doctor

Angioplasty

2007-03-10T06:56:00.000-08:00

Angioplasty:

This procedure, along with stenting, has been proved to protect the heart or prolong life only in people highly susceptible to heart attack; in everyone else, it appears only to ease angina. Further, the procedure has risks,including, in 2 to 6 per cent of patients, heart attack, stroke, or death.And the long-term safety and efficacy of drug-coated stents remain unknown.

● RECOMMENDATION:

Consider angioplasty plus stenting only if you have a history of heart attack or unstable angina, or if tests show significant(more than 70 percent) blockage,and lifestyle changes plus drugs haven’t relieved angina adequately. If you have blockage in multiple arteries or the main artery, or diabetes plus angina, ask your doctor whether bypass surgery would better relieve your symptoms and prolong your life.

Angioplasty

2006-12-27T23:29:00.000-08:00

Angioplasty:

Angiography

2006-12-25T21:35:00.000-08:00

Angiography

The American College of Cardiology recommends generally limiting angiography to people who have angina, or heart-related chest pain, as well as abnormal results on a cardiac stress test; that’s a simpler, safer, less-expensive procedure that measures the heart’s function while it’s stressed by exercise or medication. But a substantial number of doctors ignore that guideline and skip the stress test before angiography.

● RECOMMENDATION:
Agree to angiography without a stress test only if you have heart related chest pain and one of the following conditions, which make that preliminary test excessively risky: unstable angina(heart pain that strikes when you’re resting or gets progressively worse), aortic stenosis(narrowing of the heart’s main value), or congestive heart failure(inadequate pumping). And don’t undergo the calcium test to determine the need for angiography.

Surgery Section

2006-12-25T21:18:00.000-08:00

SURGERIES - YOU MAY BE BETTER OFF WITHOUT

►Before you have these invasive procedures, check out safer alternatives

Here are a dozen invasive procedures that may be overperformed,plus the safer or more effective alternatives you should at least consider.

» Too many heart procedures

Blockage of the arteries feeding the heart can lead to a heart attack. But procedures to detect or treat such blockage may be overused. One such procedure is angiography,in which cardiologists inject dye into the coronary arteries to make them visible on an X-ray. The test can lead physicians to find clinically insignificant obstructions, which they may then treat aggressively.

Such treatment often involves angioplasty, in which cardiologists snake a tiny balloon up into a narrowed coronary artery and then inflate it to crush the blockage, then they insert a cylinder called a stent to prop the vessel open. But in 1995 researchers determined that nearly one-third of those procedures were performed when medication and lifestyle changes alone would suffice or, less often when bypass surgery was the better choice.

»Women’s choice

Two of the most frequently performed major operation on women are hysterectomy, or surgical removal of the uterus and often the ovaries, and caesarean section. In both cases research suggests that most physicians fail to follow treatment guide-lines.Episiotomy, a less invasive but even more dubious procedure in which physicians make a short incision to widen the vaginal opening during childbirth, is another overdone one.

»For Males Only

Studies suggest that prostate problems − including cancer and benign enlargement− are often treated by invasive procedures without adequate discussion of the alternatives. But the best approach for both may sometimes be no treatment or watchful waiting. When completely informed about alternatives prostate treatments, men tend to choose less-aggressive options. But male patients have no say about another extremely common and medically unnecessary procedure: circumcision.