I must admit, before I began experiencing angina in late 2003 and I finally told my family physician about it in the spring of 2004, I had no idea there were two types of cardiologists.Â I thought a heart doc was a heart doc. She sent me to a doctor whose business card said “cardiologist,” It wasn’t until he tried to coerce me into receiving a quintuple bypass and I vehemently rejected the notion, instead opting for a second opinion, that I found out there are two types of heart docs, Invasive and Noninvasive. And the division between them is bigger than that between the Catholics and Protestants in Northern Ireland.
This is especially true in the treatment of coronary artery disease. The invasive doctor’s treatment of choice is invariably an angiogram followed by stents or a coronary artery bypass graft.Â The CABG realistically helps about three to five percent of the patients who undergo them. Of course it rewards the invasive cardiologist much much more than his noninvasive cousin receives for his services. The noninvasive cardiologist believes that upwards of 95% of patients with CAD can be successfully treated with medication alone.
Why does the surgical solution seem to be more popular than the medical? Besides money, it may have to do with the trials done to determine which thderapy was the most efficacious. Essentially, the noninvasive group was set up for failure by the invasive group. The cutters selected only patients who were good candidates for surgery, those with reasonable healthy coronary arteries with just a few isolated blockages. It left those patients with more severely occluded vessels to be cared for by the medicine men.
Comparing angioplasty to treatment with medication is like comparing battleships to toy boats. First of all, the medically treated patients, besides being sicker, were treated using many different protocols. The deck was stacked toward the cutters, not the pill poppers.
Despite the unfairness of the noninvasive versus invasive trials, those physicians who treated only with medication still were usually proven to be just or almost as effective as those who used a scapel.
The tide is starting to turn and noninvasive cardiologists are starting to receive their long overdue recognition. The multislice CT is an example of state-of-the-art medical diagnostic equipment that noninvasively gives the physician a better picture of the coronary arteries than the old gold standard but invasive angiogram, which really is a worthless test anyway.
In a recent study, multislice CT had a “high sensitivity and specificity for predicting obstructive CAD” when compared with angiography.Â Angiograms will soon be the fool’s gold standard as another invasive procedure becomes obsolete.
The other day, I reported the opinion of Dr. Nortin Hadler who said if he had a heart attack, he would never allow a cardiologist to use an invasive technique on him before trying to treat him with medication. He is a physician. Why should you, a patient, accept any less.
Always get a second opinion from a non invasive cardiologist.
Wordworks2001 is a retired US Army master sergeant. He resides in Indiana and works in Nigeria. He blogs at http://wordworks2001.blogspot.com