Heart check-up - is an echocardiogram needed?

[simon43]

I've been training to run a 10Km race later this year, (I now run 10Km in 60 minutes every second day without any health concerns). I'm 58 years old.

 

My last heart check-up (stress test) was 3 years ago and everything was fine with my heart.  So it's sensible to have a new heart check-up because of my regular running.

 

I have made an appointment at BNH in Bangkok for a heart check-up, and I mentioned that I am fit, training daily, and have had no heart concerns.

 

The appointment came back for an exercise stress test (4,700 baht), EKG (540 baht) and an echocardiogram (5,200 baht).

 

In my check-up 3 years ago, I had a stress test and EKG.  Dr Google tells me that I only need an echocardiogram if I have had some heart scares, such as rapid heart rate during running, feel faint etc etc.  I've never had any concerns about my heart at all.

 

The cost of 5,200 baht is not the issue - I'd just like advice as to whether it is advisable to have an echocardiogram or just the stress test and EKG.

[Naam]

10 minutes ago, simon43 said:

I'd just like advice as to whether it is advisable to have an echocardiogram

yes it is advisable! what Dr. Google does not mention is the important "ejection fraction" (pumping effiency) which can not be determined by a stress test or EKG. 

[Sheryl]

Not necessary in an asymptomatic person with no clinical signs of heart failure and no detectable heart murmer.

[simon43]

Quote

 

Not necessary in an asymptomatic person with no clinical signs of heart failure and no detectable heart murmer.
 

 

 

Thanks Sheryl, that's what I thought.  My last stress/EKG in 2014 was all fine and I have had no health concerns in my recent (last 4 months) of jogging and cycling.  I monitor my HR every Km when I jog.

 

 In a 10 Km jog at 9 kph, it starts from about 136 bpm and slowly reaches about 166 bpm after 10 Km. (My maximum HR is about 185 bpm, but I would stop an exercise if it reaches above 180 bpm).

 

When I increased my pace to 9.5kph 2 days ago, my HR after 10km was about 178 bpm.  But today in the same routine at 9.5kph, it was back to 136 - 166 bpm.  So it seems that my stamina is getting better as I slowly increase my pace every few weeks.

 

Of course, if the hospital EKG and/or stress test indicated some issues, then I would certainly have the echocardiogram (or other tests as advised).

 

Edit:

 

@Naam - I spoke with Dr Google about Ejection Fraction, and he asked me if I got tired during my running (I don't - I stop at 10Km ==> about 1 hour of running because the treadmill clock stops working after 60 minutes!). I don't get short of breath and my feet are lovely always - they don't get swollen, (which is apparently another symptom).

Edited June 2, 2017 by simon43

[Naam]

it's up to you Simon whether you want to waste the princely sum of 5,200 Baht and 15 minutes of your time to gain some additional cardio information which might aasist a future diagnosis in case that is required. ejection fraction is only a part of the data that is collected by an ECG.

[simon43]

Naam, I understand your point. Sheryl and Dr Google tell me that an echocardiogram is not required, unless something unusual shows up during the exercise stress test or EKG measurements, or unless I have had some symptoms during my exercise regime that cause me concern.

 

In any case, I haven't totally rejected the idea - I question whether it is necessary and wonder if the hospital is simply trying to get some extra money from me.  I might well have this test, if only because I've never had one before and - as you say - that extra measurement data may help with some diagnosis in the future.

[phkauf]

2 hours ago, simon43 said:

Naam, I understand your point. Sheryl and Dr Google tell me that an echocardiogram is not required, unless something unusual shows up during the exercise stress test or EKG measurements, or unless I have had some symptoms during my exercise regime that cause me concern.

 

In any case, I haven't totally rejected the idea - I question whether it is necessary and wonder if the hospital is simply trying to get some extra money from me.  I might well have this test, if only because I've never had one before and - as you say - that extra measurement data may help with some diagnosis in the future.

Simon,

I used to have the same belief about tests done for "just in case", but my closest friend who is a cardiologist at one of the top hospitals in the US strongly advises against them. His reasoning is that these tests VERY often lead to false or very minor indications, which leads to more invasive (and costly) testing. It's these more invasive tests that can lead to further complications all for no reason.

As Sheryl mentioned, if you are asymptomatic no reason to get the test. These tests are very profitable for the hospital and while an echo is non-invasive, it could lead to other more expensive and invasive tests.

Also since you mentioned that your track your heart rate while exercising, my friend told me the important thing to track is the drop in heart rate the first minute after you finish your run. It should be at least 11 beats/minute. 

Hope this helps.

 

[simon43]

... important thing to track is the drop in heart rate the first minute after you finish your run. It should be at least 11 beats/minute. 

 

Yes I do this.  My HR drops rapidly from a high of about 165 after a 10Km run to below 140 after 2 minutes and thence all the way down to my resting HR of 60 bpm.

[Naam]

3 hours ago, phkauf said:

my closest friend who is a cardiologist at one of the top hospitals in the US strongly advises against them.

[lopburi3]

18 minutes ago, Naam said:

But we are not talking about engineers hearts.  

[Sheryl]

Ejection fraction is used to monitor response to treatment in people with heart failure ans valvular disease. It is also commonly used to decide when to operate on damaged heart valves as opposed to managing conservatively.

It has little or no utility as a screening tool and there is nothing to be gained by doing it in asymptomatic people with not clinical signs of heart disease. You will not be asymptomatic if you are in heart failure. You will have an easily detectable murmer if you have a valve problem that is anyywhete near bad enough to warrant treatment.

The cardiac problem which you can have without any clinical signs is coronary artery disease. A periodic sttess test is advisable for that reason in men over say 40 and post-menopausal women.

[tartempion]

Thai private hospitals are expensive (I would like to use an other word but will refrain)
I had a miocardial infarct in 2000 and need a yearly check up, details as mentioned in OP. I do this during my yearly trip to Belgium, last month, had to pay 155 euro, social security paid back 130 euro. It pays to keep your insurance alive.


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[simon43]

It pays to keep your insurance alive.

 

I do have comprehensive private medical insurance cover.  But it won't cover the cost of these tests because I do not have (AFAIK) any heart condition (or any other pre-existing medical condition).

 

I have regular OPD health check-ups because of my age and because of my running/fitness/diet regime etc - I'm happy to pay the money to confirm my continuing health.

[Naam]

2 hours ago, tartempion said:

Thai private hospitals are expensive (I would like to use an other word but will refrain)

you get what you pay for. when i have an appointment with a specialised medic at 10.30 i expect to see him not later than 10.45 and i'm gladly willing to pay for the consultation a fraction of what i paid in the U.S. 20 years ago for taking my temperature, weight and blood pressure  before i see the doctor. of course i might save a few hundred Baht in a government hospital if i am willing to hang around waiting perhaps some hours.

[lopburi3]

30 minutes ago, Naam said:

you get what you pay for. when i have an appointment with a specialised medic at 10.30 i expect to see him not later than 10.45 and i'm gladly willing to pay for the consultation a fraction of what i paid in the U.S. 20 years ago for taking my temperature, weight and blood pressure  before i see the doctor. of course i might save a few hundred Baht in a government hospital if i am willing to hang around waiting perhaps some hours.

It is not only the wait - but the conditions of that wait.  Basic at best seating; and never enough, so if you have back issues it can be murder - and most of us would feel guilty having a seat when others have to sit on floor or even stand.  Little or no information from staff.  Often  very rushed consultation (even when paying and having specific doctor - although admit that can happen in private settings also).  

[Naam]

7 minutes ago, lopburi3 said:

It is not only the wait - but the conditions of that wait.  Basic at best seating; and never enough, so if you have back issues it can be murder - and most of us would feel guilty having a seat when others have to sit on floor or even stand.  Little or no information from staff.  Often  very rushed consultation (even when paying and having specific doctor - although admit that can happen in private settings also).  

i don't have any personal experience but you confirmed what i heard from others.

[impulse]

1 hour ago, Naam said:

you get what you pay for. 

 

If that were true, why would you ever buy anything that's on sale?  Wouldn't you wait until it goes back to full price?

 

I don't disagree with your observations about hospitals.  Just that old plum that we always hear right before or right after someone shoots us a high price...

 

Edit:  BTW, back on topic, I passed my quarterly EKG and annual stress tests for years in a row, but ended up with bypass surgery when I insisted on the next round of tests and they showed severe blockages.  I'm convinced I would have been able to have angioplasty and stents had I insisted on the echo/CAT/angiogram years earlier.  By the time they did catch it, the blockage was 100%/95% and the attempt to place stents was unsuccessful.  So I ended up with 3 or 4 bypass grafts.  No fun at all.

 

I'd pop for the 5200 baht.  Full disclosure, though- I was not asymptomatic, but always active and didn't slow down during those years leading up to the bypass.

 

Edited June 4, 2017 by impulse

[Naam]

1 hour ago, impulse said:

So I ended up with 3 or 4 bypass grafts.  No fun at all.

no fun indeed! had 4 coronary and 1 aorta bypass in 2008.

[impulse]

10 minutes ago, Naam said:

no fun indeed! had 4 coronary and 1 aorta bypass in 2008.

 

So I think you and I would agree that 5200 baht is cheap if it increases the odds of catching things while angioplasty and stents (or even simple lifestyle and diet changes) are an option?

 

Regardless of what the tests say, you always have the option to ignore them and to decline the next round (in response to phkauf's friend)

 

That's not even getting into a discussion of the hit and miss diagnostic skills here in Thailand.

 

 

Edited June 4, 2017 by impulse

[Naam]

1 minute ago, impulse said:

So I think you and I would agree that 5200 baht is cheap if it increases the odds of catching things while angioplasty and stents are an option?

agree 100%! on the other hand... 5,200 Baht buy a lot of Chang or Leo in Makro

[lopburi3]

But echocardiogram test is not for coronary issues where stent or angioplasty are used - it is a test of your heart and valves.  I was ordered to have due to major operation to make sure heart would be able to cope (by government hospital).  Private hospital where I actually had operation used a Chemical Stress Test to confirm heart could cope.

[Naam]

1 hour ago, lopburi3 said:

But echocardiogram test is not for coronary issues where stent or angioplasty are used - it is a test of your heart and valves.

because coronary issues have nothing to do with the heart and its functions?

[Sheryl]

By coronary issues he means coronary artery disease, the usual cause of heart attacks. echocargiopgrams are not very useful  for this. As I have tried to explain, echos are not useful as a screening tool in asypmptomatic people.

 

The best screening tool fopr CAD is the stress test, which if it indicates a problem tghen needs to be followed by an angiogram. Angiograms are invasive so reserved for people with symptoms or stress test results suggestive of CAD.

[lopburi3]

This is the current Bangkok Heart Hospital promotion for either EST or Echo heart exam/tests.  Price for either program is 7,900 baht.

http://www.bangkokhospital.com/index.php/en/packages-promotions/45-years-bdms-heart-screening-package?utm_source=Taximail&utm_medium=email&utm_campaign=Bangkok_Hospital_ENewsletter_June_July_2017

[1FinickyOne]

Hi Simon - I would surely go along with anything Sheryl says as she seems to be more knowledgable and better able to communicate than any doctor I have had anywhere... 

 

And not to contradict her but I would add that the question is will the extra tests give you peace of mind? That seems to be what you are paying for... 

[alfieconn]

On 6/2/2017 at 7:57 PM, simon43 said:

 

Thanks Sheryl, that's what I thought.  My last stress/EKG in 2014 was all fine and I have had no health concerns in my recent (last 4 months) of jogging and cycling.  I monitor my HR every Km when I jog.

 

 In a 10 Km jog at 9 kph, it starts from about 136 bpm and slowly reaches about 166 bpm after 10 Km. (My maximum HR is about 185 bpm, but I would stop an exercise if it reaches above 180 bpm).

 

When I increased my pace to 9.5kph 2 days ago, my HR after 10km was about 178 bpm.  But today in the same routine at 9.5kph, it was back to 136 - 166 bpm.  So it seems that my stamina is getting better as I slowly increase my pace every few weeks.

 

Of course, if the hospital EKG and/or stress test indicated some issues, then I would certainly have the echocardiogram (or other tests as advised).

 

Edit:

 

@Naam - I spoke with Dr Google about Ejection Fraction, and he asked me if I got tired during my running (I don't - I stop at 10Km ==> about 1 hour of running because the treadmill clock stops working after 60 minutes!). I don't get short of breath and my feet are lovely always - they don't get swollen, (which is apparently another symptom).

 

As a matter of interest how did you arrive at that figure ?

[simon43]

As a matter of interest how did you arrive at that figure ?

 

I assume you mean the phrase that you highlighted ==> my maximum HR is about 185 bpm.

 

There are various ways to do this.  But the quickest (and maybe most exhausting way) is to jog on a treadmill whilst continually monitoring your HR.  Gradually increase the treadmill speed faster and faster until you are running at the fastest pace that you can manage without collapsing!  Before you hit the emergency stop button on the treadmill, note your HR.

 

That's a very simplified explanation.  If you Google maximum HR, you'll find a more detailed explanation.

 

When I jog, my maximum HR never seems to go above about 166 bpm. Every week, I increase the pace by about 0.3kph.  So right now, I'm jogging 10km at 10kph.  My heart rate is still about 166 bpm after 10km (1 hour).

 

I have absolutely no concerns about the health of my heart - I am simply being 'prudent' to take these heart tests, just in case the 0.0000001% chance of having a heart issue is identified.

 

@Lopburi3, I checked that BNH package price.  It expires 1 day before I'll be in Bangkok!!

[alfieconn]

1 minute ago, simon43 said:

 

 

 

I assume you mean the phrase that you highlighted ==> my maximum HR is about 185 bpm.

 

There are various ways to do this.  But the quickest (and maybe most exhausting way) is to jog on a treadmill whilst continually monitoring your HR.  Gradually increase the treadmill speed faster and faster until you are running at the fastest pace that you can manage without collapsing!  Before you hit the emergency stop button on the treadmill, note your HR.

 

That's a very simplified explanation.  If you Google maximum HR, you'll find a more detailed explanation.

 

When I jog, my maximum HR never seems to go above about 166 bpm. Every week, I increase the pace by about 0.3kph.  So right now, I'm jogging 10km at 10kph.  My heart rate is still about 166 bpm after 10km (1 hour).

 

I have absolutely no concerns about the health of my heart - I am simply being 'prudent' to take these heart tests, just in case the 0.0000001% chance of having a heart issue is identified.

 

@Lopburi3, I checked that BNH package price.  It expires 1 day before I'll be in Bangkok!!

Just that the general consensus for calculation  is approx 220 minus your age  which put's your max HR at 162  which is obviously quite a difference to 185 !

[simon43]

Just that the general consensus for calculation  is approx 220 minus your age  which put's your max HR at 162  which is obviously quite a difference to 185 !

 

That 'general consensus' has been disproven, and it can be up to about 30bpm in error :)

 

It is especially found to be in error for people who are athletes or very fit. My current state of fitness seems to be very good, with a resting HR of about 54 bpm and running 10km in 1 hour, (which is not bad at 58 years old).

 

When I jog for 1 hour, I never get tired.  My heart never races, I don;t get short of breath and I don't get a stitch.  I stop after 10km because that is the distance that I'm happy to train for, (as opposed to running a marathon).  Over the next few months, I expect to reduce my 10Km time to about 50 minutes as I increase my pace.

 

 

[impulse]

On 6/7/2017 at 1:48 PM, Sheryl said:

By coronary issues he means coronary artery disease, the usual cause of heart attacks. echocargiopgrams are not very useful  for this. As I have tried to explain, echos are not useful as a screening tool in asypmptomatic people.

 

The best screening tool fopr CAD is the stress test, which if it indicates a problem tghen needs to be followed by an angiogram. Angiograms are invasive so reserved for people with symptoms or stress test results suggestive of CAD.

 

You yourself have stated that there is often a problem with the interpretation of the stress test related to bringing the heart rate up high enough.  

 

Quoting my cardiologist, "stress tests will catch 90%".  Having been (apparently) in the 10% that gets missed -and on several consecutive annual stress tests- I'm of the opinion that 5200 baht is cheap to go onto the next level.  

 

Since I was presenting with shortness of breath (which they seem to have been interpreting as the BKK heat and not enough exercise), angiogram would have been my preference (in retrospect knowing what I do today), but both of my cardio guys declined to do the angiogram before doing the echo- because it is invasive.  Had they gone onto the echocardiogram, then angiogram 3 years earlier, I may have stents today instead of bypass grafts.

 

Edit:  My comments aren't aimed at simon43, who seems to have a pretty good handle on his own situation.  They're aimed at others who may be wondering if they're getting great diagnostic service here in LOS when they suspect something's amiss, yet their Thai doctors send them away -often repeatedly- with a clean bill of health.

 

Edited June 17, 2017 by impulse