Routine physical

Stephen Nagler <[email hidden]> wrote in
:"]news:[email hidden]:

Quoted message said:

What is the current feeling about the appropriate cardiac testing for an asymptomatic normotensive
non-smoking 55 year old male going for a routine physical exam?

Obviously a lipid profile and EKG are in order.

But what is the thinking about stress testing, MRI/CT, etc.?

Thanks -

smn

If the 55 yr old is symptom free and at low risk, then what would the point of the EKG be?
The physical should assess the risk for disease and prescrtibe appropriate tests based on
those findings.

Not much.Total chol, and blood pressure. Personally, I'd ask for:
lipid profile, CRP test, Hba1c test. The squeaky wheel gets the oil!
Not much. See google.comsearchOpen ↗

Stephen Nagler <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

What is the current feeling about the appropriate cardiac testing for an asymptomatic normotensive
non-smoking 55 year old male going for a routine physical exam?

Obviously a lipid profile and EKG are in order.

But what is the thinking about stress testing, MRI/CT, etc.?

Thanks -

smn

Quoted message said:

If the 55 yr old is symptom free and at low risk, then what would the point of the EKG be?

A baseline to identify possible future problems. I known 'normal' EKG for an individual makes a
better comparison than the hypothetical 'average' EKG that you'd be using otherwise if you had a
case of chest pains or other suspected problem.

--
* PAUL K. BRANDON [email hidden] *
* Psychology Dept Minnesota State University *
* 23 Armstrong Hall, Mankato, MN 56001 ph 507-389-6217 *
* mankato.msus.eduwelcome.htmlOpen ↗ *

On 10 Feb 2004 12:06:55 -0800, [email hidden] (Brad

Sheppard) said:

Not much.Total chol, and blood pressure. Personally, I'd ask for: lipid profile, CRP test, Hba1c
test. The squeaky wheel gets the oil! Not much. See google.comsearchOpen ↗
8&q=Guidelines+for+routine+physical+exam

...............

Appreciate your opinion, Brad. And thanks also for the link. Very helpful.

smn

[email hidden] (Paul Brandon) wrote in
:"]news:[email hidden]:

Quoted message said:

Quoted message said:

If the 55 yr old is symptom free and at low risk, then what would the point of the EKG be?

A baseline to identify possible future problems. I known 'normal' EKG for an individual makes a
better comparison than the hypothetical 'average' EKG that you'd be using otherwise if you had a
case of chest pains or other suspected problem.

A "baseline" would assume that the day you have it done is representative. The "baseline" will be
safely tucked into the medical records kept at he doctor's office. The day you need it for
comparison, you will likely be in the emergency room; the "baseline" safely kept in the doctor's
office will be unavailable. MI's and arrhythmias produce distinctive patterns that can be
recognized; a "baseline" for comparison purposes is no more necessary than "baseline" blood tests.

Nigel said:

A "baseline" would assume that the day you have it done is representative. The "baseline" will be
safely tucked into the medical records kept at he doctor's office. The day you need it for
comparison, you will likely be in the emergency room; the "baseline" safely kept in the doctor's
office will be unavailable.

This is not always the case. My physician and ER near me are part of a University medical group.
They are able to (and I have seen it done) pull up records from regular physician visits, as well as
radiology and specialist reports, in the ER on their linked computer system.

"Dr Chaos" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Nigel said:

A "baseline" would assume that the day you have it done is representative. The "baseline" will
be safely tucked into the medical records kept at he doctor's office. The day you need it for
comparison, you will likely be

in

Quoted message said:

Quoted message said:

the emergency room; the "baseline" safely kept in the doctor's office will be unavailable.

This is not always the case. My physician and ER near me are part of a University medical group.
They are able to (and I have seen it done) pull up records from regular physician visits, as well
as radiology and specialist reports, in the ER on their linked computer system.

fyi. I keep a copy of my EKG in my wallet. (They can make an extra copy when they do one.) It is a
bit anomalous since I had an MI about 13 years ago.

Bill

[email hidden] (Paul Brandon) wrote in message news:<[email hidden]>...

Quoted message said:

Quoted message said:

If the 55 yr old is symptom free and at low risk, then what would the point of the EKG be?

A baseline to identify possible future problems. I known 'normal' EKG for an individual makes a
better comparison than the hypothetical 'average' EKG that you'd be using otherwise if you had a
case of chest pains or other suspected problem.

From the Framingham Heart Study data, about 25% of heart attacks are "silent."

By definition, these folks will be symptom free.

Their EKG will be abnormal. Their doctor(s) will likely change their "low risk" assessment after see
the abnormal EKG.

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

--
Who is the humblest person in the universe?

makeashorterlink.commakeashorterlink.comOpen ↗

What is all this about?

makeashorterlink.commakeashorterlink.comOpen ↗

On 10 Feb 2004 20:34:22 -0800, [email hidden] (Dr. Andrew B.

Chung said:

From the Framingham Heart Study data, about 25% of heart attacks are "silent."

By definition, these folks will be symptom free.

Their EKG will be abnormal. Their doctor(s) will likely change their "low risk" assessment after
see the abnormal EKG.

..............

Dr. Chung -

This makes a lot of sense to me. Thanks much for your input.

smn

Bill said:

"Dr Chaos" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Nigel said:

A "baseline" would assume that the day you have it done is representative. The "baseline" will
be safely tucked into the medical records kept at he doctor's office. The day you need it for
comparison, you will likely be

in

Quoted message said:

Quoted message said:

the emergency room; the "baseline" safely kept in the doctor's office will be unavailable.

This is not always the case. My physician and ER near me are part of a University medical group.
They are able to (and I have seen it done) pull up records from regular physician visits, as
well as radiology and specialist reports, in the ER on their linked computer system.

fyi. I keep a copy of my EKG in my wallet.

I have many of my patients do the same thing.

Quoted message said:

(They can make an extra copy when they do one.) It is a bit anomalous since I had an MI about 13
years ago.

That's understandable.

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

--
Who is the humblest person in the universe?

makeashorterlink.commakeashorterlink.comOpen ↗

What is all this about?

makeashorterlink.commakeashorterlink.comOpen ↗

[email hidden] (Dr. Andrew B. Chung, MD/PhD) wrote in
:"]news:[email hidden]:

Quoted message said:

[email hidden] (Paul Brandon) wrote in message news:<paul.brandon-1002041218330001@pkbrando-
laptop.psych.mnsu.edu>...

Quoted message said:

Quoted message said:

If the 55 yr old is symptom free and at low risk, then what would the point of the EKG be?

A baseline to identify possible future problems. I known 'normal' EKG for an individual makes a
better comparison than the hypothetical 'average' EKG that you'd be using otherwise if you had a
case of chest pains or other suspected problem.

From the Framingham Heart Study data, about 25% of heart attacks are "silent."

By definition, these folks will be symptom free.

Their EKG will be abnormal. Their doctor(s) will likely change their "low risk" assessment after
see the abnormal EKG.

Silent ischemia will show EKG changes during an ischemic episode and can therefore only be diagnosed
through an exercise tolerance test. If there is damage from ongoing silent ischemia, there would be
EKG changes, however it is unlikley that the patient would be symptom-free.

Dr Chaos <[email hidden]> wrote in
:"]news:[email hidden]:

Quoted message said:

Nigel said:

A "baseline" would assume that the day you have it done is representative. The "baseline" will be
safely tucked into the medical records kept at he doctor's office. The day you need it for
comparison, you will likely be in the emergency room; the "baseline" safely kept in the doctor's
office will be unavailable.

This is not always the case. My physician and ER near me are part of a University medical group.
They are able to (and I have seen it done) pull up records from regular physician visits, as well
as radiology and specialist reports, in the ER on their linked computer system.

So youstay close enough to home that in the event of an emergency you will only be taken to that ER?

You snipped the last part: MI's and arrhythmias produce distinctive patterns that can be recognized;
a "baseline" for comparison purposes is no more necessary than "baseline" blood tests.

I assume that means you have no argument.

Nigel said:

[email hidden] (Dr. Andrew B. Chung, MD/PhD) wrote in
:"]news:[email hidden]:

Quoted message said:

[email hidden] (Paul Brandon) wrote in message news:<paul.brandon-1002041218330001@pkbrando-
laptop.psych.mnsu.edu>...

Quoted message said:

>If the 55 yr old is symptom free and at low risk, then what would the point of the EKG be?

A baseline to identify possible future problems. I known 'normal' EKG for an individual makes a
better comparison than the hypothetical 'average' EKG that you'd be using otherwise if you had
a case of chest pains or other suspected problem.

From the Framingham Heart Study data, about 25% of heart attacks are "silent."

By definition, these folks will be symptom free.

Their EKG will be abnormal. Their doctor(s) will likely change their "low risk" assessment after
see the abnormal EKG.

Silent ischemia will show EKG changes during an ischemic episode and can therefore only be
diagnosed through an exercise tolerance test.

Correct.

Quoted message said:

If there is damage from ongoing silent ischemia, there would be EKG changes, however it is
unlikley that the patient would be symptom-free.

If there are symptoms, the ischemia is no longer silent, Nigel.

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

--
Who is the humblest person in the universe?
makeashorterlink.commakeashorterlink.comOpen ↗

What is all this about?
makeashorterlink.commakeashorterlink.comOpen ↗