Stress test gives details on blockages
Dear Dr. Roach: My primary care doctor prescribed a cardiac calcium test after seeing me breathing hard while climbing onto the examining table. I don’t feel a need for it, as I am over 72 years old. Since then, I have been avoiding the test. What is your advice?
J.M.
Answer: When people have difficulty breathing with pretty minimal exertion, I would be concerned that there is a problem. Blockages in the blood vessels to the heart muscle — coronary artery disease — is one common and treatable cause of breathing problems with exertion. I think a test to determine whether you have CAD is reasonable.
However, the coronary calcium score wouldn’t be my first choice. Since a coronary calcium score doesn’t provide information about whether (and how big) blockages might be, a stress test would be my first choice, followed by a definitive anatomical test, like a coronary angiogram, if abnormal.
The coronary calcium score is best used for higher-risk asymptomatic people, especially when trying to get more evidence to weigh the risks and benefits of medical treatment.
Dear Dr. Roach: I am 68 and have been taking benazepril to control my high blood pressure for 20 years. I often read that high blood pressure can put a person at risk for different issues, including complications with COVID-19. Since my blood pressure is within normal range with medication, am I still at risk for high blood pressure issues?
M.R.W.
Answer: High blood pressure does put people at higher risk for medical issues, especially stroke and heart attack. It is my belief that a person who is rapidly diagnosed with high blood pressure once it occurs, and who is treated aggressively and successfully, will be at no (or very little) increased risk for high blood pressure and stroke.
While it is true that high blood pressure seems to be a risk factor for bad outcomes in people infected with COVID-19, I can’t say definitively that successful treatment completely removes that excess risk. However, I believe that is likely to be the case.