Was it you that had some heart problems in the past that were sort of misdiagnosed? I’m trying to remember a series of post made a bit ago about heart rate, heart problems etc. I did I search and didn’t have any luck. Has to do with my father and a stress test he just had. Said he had a silent heart attack, etc. Said his heart is skipping a beat. But he has this really low resting heart rate. He’s 68 and it’s like 38 to 40. Always has been but he’s run for 50 years. And is in really good health.
Silent heart attack diagnosis is made strictly off the EKG although, to the lesser experienced clinician, there are some conditions found in the athlete that could fool one into an incorrect diagnosis.
Heart attacks caan occur in the experienced runner (see: Jim Fixx) but if there is no family history of early heart death it would be very unlikely in the situation you describe.
Get a second opinion from a cardiologist who is an endurance athlete.
What are those conditions that might cause misdiagnoses? He had the whole gammet of test not just a stress test. They want to put him on a beta blocker becuase they say his heart rate is irregular at times. I thought I read a beta blocker slows down your heart rate. My parents are very concerned. Worried about an unneeded drug. They take nothing except for asprin and vitamins.
I already suggested trying a different doctor for a second opinion.
Frank, you never cease to amaze me with how opinionated you are. First, NCCB didn’t say specifically that his dad was even seeing a cardiologist. Many primary care MDs do stress tests in the office, and there is nothing wrong with a competent primary care person managing mild coronary artery disease or chronic stable angina. With the impending shortage of medical specialists in fact you should expect to see more of it. Secondly, don’t complicate matters for this man and his family by suggesting they find “a cardiologist who is an endurance athlete”. Hobbies don’t make a good doctor: a doctor who knows his shit makes a good doctor…and it doesn’t take much expertise to be able to distinguish “athlete’s heart” from LVH related to HTN or hypertrophic cardiomyopathy.
NCCB: thickened left ventricles are common in endurance athletes and this induces many changes in the baseline EKG. Also, the enlargement of the LV can appear superficially the same as what one might see from long standing hypertensive heart disease or hypertrophic cardiomyopathy. For any board certified cardiologist this is basic stuff which can be explained to you and your family easily.
Beta blockers are practically the standard of care for medical mgmt of coronary disease. The degree to which slowing of the HR occurs is unpredicatable and varies from patient to patient. There are also beta blockers which have intrinsic sympathomimetic activity and will less tendency to slow HR. Of course there are some pts who cannot tolerate BBs and for those other options include calcium channel blockers. ASA is absolutely essential.
The management of CAD with an old MI on EKG, without heart failure or refractory angina, is quite basic and follows a fairly straightforward treatment strategy. Let me know if you have other questions and I can email you off this forum.
Chip, whiile you are right that it doesn’t take an athlete to know his stuff, However, there was something about this story that sounded fishy, like early repolarization was being seen as cardiac ischemia or PVC’s and bradycardia being seen as pathological when it is not.
How does one tell someone how to find a doctor competent in this stuff. I just think that getting a second opinion from a cardiologist who has probably dealt with serous endurance athletes before has a better chance than not of getting the correct affirmation of the original diagnosis, if correct, or the correct diagnosis, if not.