Dr. Keith Roach: Is stress test more stressful than it’s worth?
Dear Dr. Roach: I am always asked to redo tests — echo ECG, stress test ECG, nuclear stress test. The results are barely mentioned, yet the test is always indicated another time. Is this a waste of money (for the patient)? In someone with no known blockages and no symptoms, how often should a stress test be done?
Dear M.W.: Stress tests are not routinely recommended as screening tests, which is to say for testing people with no symptoms. They can be dangerous, because like all screening tests, they can have a false-positive result, which leads to anxiety and unnecessary other tests. In the case of heart disease, the test often is coronary angiography, which is an invasive test. They also can have false-negative results, which can lead to a false sense of security and failure to get proper medical therapy.
Many physicians order these tests in good faith, because they want to help their patients. They know heart disease remains the leading cause of death, and any experienced clinician has had patients die from heart attacks, often the first heart attack. While I understand the motivation, the experts agree and the data show that getting the stress test as a screening tool is more likely to cause more harm than good.
Dear Dr. Roach: Am I wrong in believing that one is NOT supposed to administer cardiac compressions for seizures? I see health professionals, even RNs, doing it time and again after a simple seizure because they cannot get a pulse on the person.
One would not necessarily find a pulse following a seizure, correct? Please advise health professionals of the proper way to treat a person during and after a seizure, because they do not know!
Dear S.O’G., RN: Witnessing a seizure when you have not previously seen one is very frightening, and I often see well-meaning people attempt to help, but in a dangerous fashion. However, I have never seen anyone attempt chest compressions. During a seizure, trying to find a pulse may be impossible. But the heart must be working if the person is moving. Medical professionals should know better.
Here are some things to do when you witness a generalized seizure (often called a “grand mal’”or tonic-clonic seizure):
■Ease the person to the floor (if not there already) and make sure there is nothing dangerous nearby;
■turn the person onto his or her side to help breathing;
■protect the head with something soft;
■NEVER put anything into the person’s mouth; and
■avoid chest compressions or mouth-to-mouth breathing, as these almost never are necessary.
Call for emergency help if:
■the seizure is in water;
■the person injures him- or herself;
■the seizure lasts more than five minutes or a second one starts immediately;
■the person does not breathe after the seizure stops; or
■this is the person’s first seizure (look for medical alert jewelry or identification card).
After a seizure, a person is usually fatigued and confused for a period of time, and often needs help getting someplace safe. In a world where most people have a mobile phone, calling the person’s home, friend or relative isn’t hard. I recommend everyone have an ICE (in case of emergency) contact on their phone. Android and iPhone phones allow emergency access for these calls.
More information is at cdc.gov/epilepsy/basics/first-aid.htm. The Red Cross also has a very good free mobile app to help people deal with emergencies, including seizures.
Email questions to ToYourGoodHealth@med.cornell.edu.