Cardiology tests and Primary Prevention


Q: I am just 66 and have a right bundle block, but no history of heart disease in anyone in my family going back to great grandparents. So I took Atenelol for high blood pressure but pulse went to 46, so I stopped and pulse is back up. My bp was 130/80 at doctor a week ago. He suggested stress test, 24 hr. thing you wear and echocardiogram. Five years ago I had all of that, but echo. since I lost 10 lbs and walk up and down steep hills daily with no problem and feel wonderful. I do not want all those tests. Do you think they are necessary from what I have written? Thank you.


A:   Medical doctors are trained in both preventive and acute care. The majority of doctors prefer preventing problems in their patients lives through advise on lifestyle modifications and preventative screening. Sadly, the majority of patients only present to us after something life altering has taken place.  I think it is great you are seeing your doctor on a regular basis and he is practicing prevention over treatment.
Statistically, heart disease is one of the top two causes of mortality and morbidity in your age group. While a right bundle branch block is often benign, I agree with your doctors suggestion for cardiac screening.  Depending on your medical history, some doctors may even recommend the tests you mentioned annually. I think in your case, repeating the tests after 5 years is reasonable.  Furthermore, the tests you mentioned are non invasive and carry virtually no risk to you other than your time.
From another stand point, if something did happen, you would hate for your insurance claim to be denied because you did not comply with medical recommendations.
It's hard for me to argue against your doctors suggestions in this case. The ultimate decision is yours.

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