A Change in Symptoms Means a Change in Treatment
A friend that I have known for some time called me and said he was having a symptom that worried him. He is very interested in his health and he does what he can to keep it. He walks a couple of miles a day faithfully. He is eating healthier. He has lost weight. He takes his medications faithfully, but he had a new symptom. He was rapidly becoming exhausted when he tried to walk, and it was getting worse pretty quickly. It was a new pattern for him. He had been to his primary care doctor who began to work him up for fatigue and did tests for low thyroid and anemia, but this man had a history of bypass surgery over a decade ago. He was on optimal medical therapy. I told him that he should see a cardiologist immediately. His change in symptoms, especially with decreasing levels of exertion could be a sign that a cholesterol deposit had ruptured and was forming a clot that was slowly or intermittently progressing. In that setting, urgent stent placement can be lifesaving and save heart muscle. His evaluation did show blockages and he received a stent leading to an improvement.
Lesson Exertional fatigue or exhaustion alone that is occurring with decreasing levels of exertion may be a sign of unstable heart artery disease that may lead to a heart attack or sudden death. In fact, it is entirely possible to have a heart attack with only fatigue as a symptom. Individuals may have a heart attack that is silent-no symptoms. Changing symptoms that appear with exertion and go away with rest— especially if they are getting worse— are a reason to pursue urgent evaluation by a cardiologist. Here urgent heart artery stent placement can be lifesaving. There is another lesson. If symptoms of cardiovascular disease are stable, a stent is almost never justified. Opening arteries mechanically is consistent with best practice in left main coronary artery disease, unstable angina, or heart attack. Otherwise, it is almost always not appropriate. Here’s the rub. Our health system in the United States is still focused on finding and opening heart artery blockages and most patients do not receive optimal medical treatment which should be a universal standard of care.