Comments on: A New Sign in medicine: the Tim Russert sign

By: jeffrey dach md

jeffrey dach md — Tue, 01 Jul 2008 12:29:54 +0000

Tim Russert and George Carlin Two beloved American celebrities have succumbed to heart disease before their time. The national response has been disappointment in a medical system that could allow this to happen. What could have been done differently to save the lives of both Tim and George, to avoid this fatal outcome? To read more...Saving Tim Russert and George Carlin by Jeffrey Dach MD Jeffrey Dach MD 4700 Sheridan Suite T Hollywood FL 33021 my web site

By: Zoe

Zoe — Sun, 22 Jun 2008 02:09:47 +0000

The news chatter is wondering whether a nearby portable defibrillator would have saved him. But given his thrombosis won’t the only thing that might have helped was an immediate dose of TPA?
This isn’t my field – what do you med-types think?

Thanks

By: Steve

Steve — Sat, 21 Jun 2008 01:36:57 +0000

In the insurance mind, Tim Russert cost the insurance company less as he died, than if he had been effectively screened and entered the system to treat him aggressively before his untimely catastrophe.

This is truly a frightening statement. Given that Russert is probably very wealthy, I wonder why he or his doctors didn’t insist on the state-of-the art tests regardless of what the insurance companies would or wouldn’t reimburse.

But once a standard stress test eliminates the probability of an imminent heart attack with the greater than 70% blockage, the treatment plan for mild blockage would be cholesterol control, diet, exercise, smoking avoidance, BP control. Shouldn’t these things be a part of everyone’s health treatment? What do the state of the art tests add then? A sense of urgency? Patient incentive to follow doctors orders?

By: Michael

Michael — Sun, 15 Jun 2008 15:27:24 +0000

RE: E Bough
As a cardiologist, I agree with E Bough. The idea that a stress test means you are “normal” is false, and has always been false. Stress testing is to detect flow-limiting stenoses, or narrowings, in coronary arteries. Usually this requires narrowing of at least 50%, and sometimes 70%. This test doesn’t mean you do not have coronary artery disease, or plaque. Many people have mild coronary artery plaquing that is “asymptomatic”, meaning it isn’t causing pain, but it still has very important implications. Most heart attacks are caused by mild narrowings from a plaque which then ruptures, somewhat like a pimple, exposing raw plaque contents and artery wall which generates powerful clotting mechanisms, and, often, occlusion, heart attack, and, sometimes, death. This is why it is important to explain to patients the marked importance of lipid control, smoking avoidance, diet, exercise, BP control.
A well-operated coronary CT can give calcium scores and demonstrate subtle plaque not detected on stress testing. This is the test to detect the presence or absence of the disease itself, i.e., coronary artery disease. These machines are available, our group has the state-of-the-art machine. Third parties, i.e., the Blue Crosses of the country, have literally declared war on this study. They employ independent companies to “screen” for “appropriateness” of the study, using out-dated, obstructive, criteria, and most of these studies are increasingly denied. In the insurance mind, Tim Russert cost the insurance company less as he died, than if he had been effectively screened and entered the system to treat him aggressively before his untimely catastrophe.

By: Dave

Dave — Sat, 14 Jun 2008 20:31:00 +0000

My father had a sextuple bypass in March. As a med student, I got his verbal story, and it sounded like he probably had an MI at the end of his stress test.

For INACTIVE overweight males > 50 y/o that don’t work out at all, much less really push themselves, it is wise to plop them onto that treadmill? It’s basically like finding a WWII grenade and pulling the pin to see if it still works, no?

By: E Bough

E Bough — Sat, 14 Jun 2008 17:32:39 +0000

This is one cardiologist’s opinion.

Routine stress tests without echo or nuclear imaging miss (diagnose as normal) up to 40% of patients with coronary artery disease and inadequate cardiac blood supply. Nuclear or echo stress tests are much better at picking up people with coronary artery disease with narrowing greater than 70%. Unfortunately, most fatal heart attacks occur from the rupture of plaques with less than 70% narrowing (because there are simply many more of them). The best tests for detecting coronary artery disease with milder stenoses are a CT calcium score or CT angiogram (even better than catherization which can miss plaque with minimal stenosis).

Russert, with “asymptomatic coronary artery disease,” must have had one of these tests. He should have been on aspirin, a beta-blocker, and a statin drug (possibly in combination with other drugs) to keep his LDL cholesterol under 70 and his HDL cholesterol over 40. Was he? His docs have not been forthcoming.

By: medicine

medicine — Sat, 14 Jun 2008 17:23:46 +0000

Yes, your right. I agree with you for the information provided in your blog. Negative stress may occur mainly if the person is facing with financial problems.I think medicine is the symptom for any problem.

By: Goatwhacker

Goatwhacker — Sat, 14 Jun 2008 13:24:45 +0000

Stress tests are far from perfect but also far from worthless. The article doesn’t say what kind of stress test Russert had but I suspect with his high profile it was a sestamibi treadmill test. They are pretty good at identifying stenosis/ischemia but what they won’t do is identify the plaque that is liable to rupture. For that matter neither will an angiogram. It looks like plaque rupture is what killed Russert.

People might criticize his evaluation but none of these tests are perfect and bad things are still going to happen sometimes. I do agree that there is a real temptation to over-utilize these tests, both from the physicians and the hospitals.

By: mo

mo — Sat, 14 Jun 2008 07:08:44 +0000

My husband had his negative stress test two days before his nearly fatal heart attack that resulted in double bypass and an ICD eight years ago. Thirty two days ago he had another negative stress test and had his second heart attack the next day. He was successfully stented.
Stress tests are the biggest joke in cardiology but more importantly they are one of the biggest money makers.
I can say this because I have spent the last ten years as a RN in the cardiovascular intensive care unit and I have read the reports from the stress tests..meaningless CYA comments with no predictive value unless the patient grabs his chest while on the damn treadmill.