heart attack

Can a coronary calcium scan improve the prediction of heart attacks in older divers?

In the July 2015 issue of Undercurrent, an article titled “A better heart-check tool than a stress test?” discusses the possible benefits of a coronary calcium scan for older divers to reduce the risk of experiencing a heart attack while diving.1 This article is a follow-up to a May 2015 Undercurrent report about an overweight 65-year-old diver who died shortly into his dive while on a dive trip.2 That article, which considered preventive options such as a stress test, also presented views from Dr. Alfred Bove and DAN’s Dr. Petar Denoble and Dr. James Chimiak, who agreed with the American College of Physicians (ACP) guidelines that recommend a graded and individualized approach to preventive testing and diagnostics.

Another physician suggests in the July 2015 article, however, that older divers should have a coronary calcium scan, which he claims may provide information that will help them avoid a heart attack on their dive trips. Many walk-in clinics offer the test at a low price. “A coronary calcium scan can tell you years before a positive stress test that you are headed in that direction [of significant coronary disease] so that you can do some kind of intervention,” he said. While the statement has merit, it may be misleading in this context.

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Heart Attack Symptoms in Women

ImageHeart disease is the leading cause of death in women and heart attack is the leading cause of hospitalization. The characteristics of this disease in women may differ from those known in men; the age of onset, presence of risk factors, probability of aggressive diagnosis and treatment vary in men and women.

For example, heart disease develops 7 to 10 years later in women than in men (potentially because of a protective effect of estrogen). Heart attack (myocardial infarction, MI) is less frequent in young women than in men, but young women with heart attack are at greater risk of dying within 28 days of the attack. Common risk factors for heart disease have similar predicting value both for men and women; however, men more frequently have smoking as risk a factor, whereas women more frequently have hypertension, diabetes, hypercholesterolemia and angina. Although women typically smoke less, the relative risk for MI of women who smoke was 1.5 to 2 times greater than of men who smoked, especially in younger age (< 55 years). Higher prevalence of diabetes contributes to higher mortality rates of MI among women.

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