Hacker News Reader

Comment by nradov | Hacker News Reader

There are lots of different types of heart disease. An ECG can be useful for diagnosing some of them but you're overstating the relative value. For many patients, a CT coronary calcium score or CT angiogram may be more valuable in terms of detecting the type of arterial plaques that might require medical management or major lifestyle modifications in order to prevent a heart attack. These are also non-invasive, although they do involve some radiation exposure.

https://www.mayoclinic.org/tests-procedures/heart-scan/about...

https://www.mayoclinic.org/tests-procedures/ct-coronary-angi...

View on HN

Having a CAC done is fairly cheap, ~$100 in the US. Insurance typically doesn’t cover it, but if anyone is concerned, it’s worth calling to set one up.

My dad’s doctor said he should get one, Medicare denied it, but he paid out of pocket to get one anyway. He found out he was 95% blocked pretty much everywhere and had a quadruple bypass. It likely added many years to his life and avoided a heart attack.

If you’re under a certain age (I want to say somewhere in your 50s), there isn’t any guidance for what normal is. If you’re in your 20s or 30s, I wouldn’t run out and get one. But if you’re in your 40s with a family history, or up into your 50s and beyond, it’s worth thinking about. I’ve also heard you’re only supposed to get them every 2-3 years, it’s not a yearly thing, due to the radiation.

(I am not a doctor)

There is a heart surgeon on YouTube / TikTok that has a couple of videos on this topic.

He says, without symptoms, never get a stent. Never get a bypass unless you have chest pains, shortness of breath, or other symptoms.

Lot of people have plugged up heart arteries. If it does not impact them, don't mess with them.

My story: 61 years old. excessive fatigue. echo cardiogram, no-exercise showed no issues. CT scan looked like a christmas tree. Heart Catheterization was unable to get into the vessels for stenting. Triple CABG a few days later.

The CT scan was easy, cheap (my insurance covered it), and fast. And it put me on path to get my heart fixed.

>echo cardiogram

The main advantage of ECG compared to echo is that it's represent the functionality of the heart and overall CVD rather than structure like echo.

CT scan is not for screening and risk prediction, it's normally recommended after discovery of CVD related symptoms.

Having said that even CT cannot detect some of CVDs since it mainly cover the vascular part of the CVD not cardio engine (heart).

ECG is the only one technique that cover comprehensive CVDs screening and it's non-invasive.

It was just added to the recommended screenings list and my doctor expects that insurance will cover it soon because of that. Still at under $100, it was well worth knowing that i don't need aggressive treatment. (Though a quadruple bypass beats a heart attack)

Then again, CAC measures end-stage calcified plaque, not the soft plaque it started as, equally clogged arteries but also able to break off to cause strokes until the body calcified it.

The time to take action is long before you have a CAC score. e.g. Start tracking ApoB regularly, see if you have genetic LPa exposure, and avoid the foods that increase your exposure while ignoring the grifters telling you it's a nonissue.

> diagnosing

GP was talking about screening though, not diagnosis. Coronary angiography are specialized, expensive and require intravenous constrast. Doctors aren't going to order them for everyone who shows up for a routine consult.

>For non-invasive heart disease risk prediction nothing beat ECG, period.

Emphasis on non-invasive diagnostic screening as invasive testing like angiogram need to be operated by specialist and can take months to be arranged, and only done after incidents e.g heart attack.

ECG is excellent for generic top level CVD anomaly conditions for examples arrhythmia and ischemia.

CT scans are non-invasive. In most US cities you can schedule one quickly. Screening tests are generally not time critical.

CT scans cannot detect some of CVDs since it mainly cover the vascular vessels part of the CVD not the function of the cardio engine (heart). The test procedure is only recommended if someone has CVD symptoms but not for screening. In most of the countries it will take months to perform the procedures and get the results due the scarcity of the facilities and the severe shortage of the cardiologist to perform the diagnostic with ratio to population of around 1:100,000.

ECG is the only one technique that cover comprehensive CVDs screening and it's purely non-invasive (no injection necessary). If someone has blocked arteries or even genetically malform heart like Hypertrophic Cardiomyopathy (HCM) it will show in the ECG traces, that can be cross checked with other relevant CVD diagnostic techniques. The main problem is that the screening GP and even the cardiologist has trouble performing the correct interpretation. This is where advanced signal processing and analytics, ML, AI, etc can really help, but somehow the heart fraternity like AHA is very much still in denial on this matter.

Please check the short overview article from Prof. Friedman on ECG based CVD detection in my other comment, ironically commemorating on the 100 years of AHA.

Reply on news.ycombinator.com