**EP06: Interesting Emergency Worker Cases**
**Warwick:** Welcome to Dr. Warwick's podcast channel. Warwick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warwick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.
My name is Warwick Bishop, and I'd like to welcome you to my consulting room. I'd like to speak with you today about two cases I've had in the last couple of weeks that have really reminded me of the difficulty we sometimes have in predicting who's going to have a heart attack. Both of these cases were emergency workers. Both of these cases were men.
The first man was just over 50 years of age. He was fit. He was well. In fact, if you walked past him on the street, you would pick him as someone who looked after himself and exercised regularly, which he did. This man, who was 52 or 53 years of age, without any substantial risk factors whatsoever, ended up in hospital with chest pain, out of the blue. That chest pain was in association with an abnormal blood test, which we call a troponin, confirming that there was some involvement of his heart, plus he had ECG changes.
He went on and had further investigation. He had angiography, and this demonstrated that he had narrowing within his artery running down the front of his heart. He'd had a blockage of the left anterior descending artery. This was completely out of the blue. This was a man who looked fit and well, and it was very difficult to even understand what had happened. As you can imagine, as you would believe, he was bemused by the outcome.
We've, of course, treated his cholesterol. He's now on aspirin, he's on blood pressure therapy, which we use as part of our treatment for myocardial infarction, and thankfully he's made a good recovery. But he's a very timely reminder of how difficult it is for us to know, looking at the outside, what the health of someone's inside is.
Literally within a week or two of this 53-year-old male ending up in hospital with me, a young man, 45 years of age, also an emergency worker, came to see me. This second man was young and fit, in very, very good condition, and in fact, went out of his way to train, regularly attending the gym and undertaking exercise, jogging, and other activities. Six months earlier, he had been to another cardiac service in Hobart, where he'd gone through treadmill testing. They had done that because there was a bad family history of premature coronary artery disease.
This young man, 45 years of age, breezed through the treadmill testing, didn't turn a hair, got to a very high capacity, and had absolutely no symptoms and no signs of a problem whatsoever. He was reassured and left it at that. His mum, however, in the intervening time, had come across a copy of my book, *Have You Planned Your Heart Attack?*, had read it, and said to her son, "Son, you really need to go and see Dr. Bishop and get another opinion."
When I saw this man, I explained to him that treadmill testing is a really good way of picking up if there's a blockage or a narrowing in the arteries, but it's not a great way of telling us if there's the beginnings of a build-up or a potential build-up in the next few years. We did speak about imaging. I explained the costs, the x-ray exposure, the radiation, and that we'll often inject some contrast. I covered the side effects or allergies as well.
This young man was still keen to have that testing done to see exactly what was going on with his arteries, and thankfully he did. Interrogation of his heart using CT imaging clearly demonstrated a plaque in the artery running down the front of his heart, which, left unattended, would run a very, very high risk of serious consequence of heart attack in the next five to ten years. This man was clearly at much higher risk than you would have imagined from looking at him, and that was suggested by his treadmill test only six months earlier.
This 45-year-old man is now on the appropriate therapy and hopefully won't end up in hospital in the same way that the 53-year-old gentleman did. Because we've had the chance to be ahead of the game, because we've had the chance to put in place therapies that will make a difference, and we've also had the chance to educate this man and raise his awareness such that if any symptoms ever do occur, he is forewarned, foreprepared, and knows exactly what to do.
Although there is no clear-cut evidence in the literature of this sort of use of technology to guide therapy in individuals like this patient, I feel confident that for this man we've made a difference that could be life-changing. The issue of using cardiac CT imaging is not yet a guideline recommendation, but I recommend it's something that you should be aware of and engage your doctor in a conversation about where it might fit for you.
I don't want to see 53-year-old men who otherwise are fit and well in hospital, surprised by a heart attack, running the risk of dying in the process. Similarly, the more I can find younger patients, a 45-year-old man whom we can do something for before an event has occurred, the better as far as I can see.
I hope you've enjoyed this short note on a couple of cases that I've seen just recently. I wish you the very best. Bye for now.
