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Dr. Roach: Is nuclear stress test unnecessary follow-up if symptom-free?

Keith Roach
To Your Health

Dear Dr. Roach: I am a 69-year-old male who underwent bypass graft surgery in late 2014. I have been free of symptoms since. I exercise daily by walking and/or cycling, maintain a healthy diet and have never smoked. I’m 5 feet, 7 inches tall and weigh 152 pounds. I’ve been on once-daily statin and metoprolol since the bypass. BP and cholesterol numbers have stayed normal, and I have no other health issues.

My cardiologist has scheduled me next month for a carotid ultrasound, echocardiogram and a nuclear cardiac treadmill stress test in what he describes as a routine five-year follow-up to my bypass procedure. I’m concerned mainly about the nuclear stress test. I read an article by the American Society of Nuclear Cardiology that stated such a test is rarely necessary in the absence of symptoms. Plus, it exposes one to radiation and may lead to false positives and further unneeded testing, which is said to be more likely to occur in a symptom-free patient. I was not aware of this fuller context when this test was scheduled. Would it be prudent for me now to question my doc about whether this test is really needed?

— K.B.

Dear K.B.: I agree with you completely.

Stress tests did used to be recommended after bypass grafting, but no longer are, for the reasons you identified. In people with no symptoms, surgery or other treatment to open up blood vessels with balloons and stents is not beneficial. Although the potential for harm is small, there is always a risk of a false positive test requiring invasive follow-up testing. Coronary angiography (also called cardiac catheterization), which can damage blood vessels, is one example. The dye used in the test can occasionally damage the kidney.

Questioning your doctor about a test he has ordered is uncomfortable for some people, but most doctors don’t feel threatened by a respectful request to explain our reasoning. Medical care ideally includes shared decision making, and although many people defer entirely to their doctors, people will get better care if they share their concerns and desires with their doctors as logically as you have here.

Dear Dr. Roach: Sadly, my older brother had a stroke a few years ago after a tumor on his pituitary gland burst and blood went into his brain. He is paralyzed on his entire right side. He is in a care facility, and there are a few more people there who are even more incapacitated than he is. I wonder how these people, who are in their 90s and pretty much totally immobile, are able to live as long as they do without having ANY physical activity. I would think their hearts, lungs, muscles, etc., would just give out due to lack of usage or stimulus.

How is it that they can continue to hang on despite having no exercise for their frail bodies?

— N.H.

Dear N.H.: I am very sorry about your brother. Visiting such care facilities can be painful, but it is so appreciated.

The human body requires regular exercise and a healthy and diverse diet to work optimally. However, we can survive for very long periods of time with no exercise and with even a poor diet, as history has shown. Our hearts and lungs are made with immense functional capacity, and are able to withstand loss due to damage or disuse for decades. Muscles will atrophy quickly when not used, although they can come back if reused. Unfortunately, a stroke often can permanently prevent muscle use.

Excellent nursing care is needed for people with paralysis, and if he is doing well with no skin problems, thank the nurses.

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