Case histories. Cardiac. Heart cases

Mr J (aged 39) was worried about his cholesterol. He had no symptoms at all. He had no
family history of heart disease at all. We took his full history, examined him for
any sign of heart disease and then tested him. His arteries showed no cholesterol
building up and his ECG and exercise ECG were normal. His blood tests confirmed
a slightly raised cholesterol with a high protective HDL component. We left him
untreated but with full dietary and lifestyle advice. We will check him again in 3 years.
TAKE HOME MESSAGE: A high blood cholesterol increases the theoretical risk of
coronary heart disease. In practice it is of little diagnostic use in individuals.

Mr S (aged 42) had a family history of heart disease. His brother and father had both dropped
dead of a presumed heart attack aged 40 and 45. He ran marathons and while in
training had noticed a little shortness of breath and a slight chest pain on one occasion.
His examination was normal as were all his blood tests and ECG at rest. On
exercise, however, he developed chest pain and signs of a severe coronary artery blockage.
Next day we proceeded to do a coronary angiogram. This showed one serious
narrowing only. Had it blocked though, he too would have dropped dead! A stent
was inserted and he still runs marathons. We check him every year - especially
his arteries with ultrasound for any sign of deterioration. His artery cholesterol
has grown a little so we doubled his ‘statin’ drugs and will do this again if it does not stop.
TAKE HOME MESSAGE: You can be in a ‘dropped dead situation’ with a ‘normal’
blood cholesterol. Family history, artery scanning and exercise testing were the useful tests.

Mrs B (aged 68) was told that she had heart disease. On exercise she had an abnormal looking ECG.
all her blood tests were normal and she had normal arteries for her age as far as cholesterol
build-up was concerned. We repeated her ECG on exercise and cobfirmed that it ‘looked’
‘suspicious’. Further testing with a perfusion and CT scan proved normal. The only problem
she had was seeming to have heart disease. Sometimes the tests can give ‘false positive’
information. By acting quickly we saved her onths of worry while waiting for the extra
tests on the NHS.
TAKE HOME MESSAGE: Not all that glitters is gold. An exercise test, on its own is only 85%
reliable.