Treat the test or treat the patient?

I received a phone call a few nights back from a physician I’ve never heard of.  Turns out he is a cardiologist and was reviewing an electrocardiogram (ECG) of one of my patients.  An ECG is an electrical record of the function of the heart.  Interpreting an ECG isn’t all that hard – after a while it really comes down to pattern recognition.

Here’s a normal ECG.   Here’s one showing a very fast heart rate, supra ventricular tachycardia.  Here’s one showing a very slow heart rate, sinus bradycardia.  And here is one that you never want to see in your office.  This last tracing is of an acute myocardial infarction – a heart attack.  A pretty bad heart attack.  Those in the medical community would call those “st segment elevations“, tombstones.  Death is near.

This particular ECG was showing some of those tombstones.  Sometimes we get test results that are scary looking, but when you look at the patient, he/she is completely fine.  So what does one do? Treat the test result or the patient?  This particular patient hadn’t been having chest pain – the ECG was ordered for another reason.  Of course, the cardiologist wouldn’t have known that.  Still, what’s the best course of action in a situation like this?  The cardiologist suggested the patient needed an urgent repeat ECG done, with bloodwork.  He could be having a heart attack, or angina.  Or maybe it was just an anomaly.  Perhaps the leads weren’t placed correctly.  In any event, one really can’t ignore such a finding.

The patient turned out to be fine.  I was able to contact him and arranged for him to go to the ER.  After speaking with the head nurse and faxing a copy of the ECG to the ER,  the patient was seen and assessed in about 6 hours.  Two ECGs later and normal bloodwork, he was discharged home with an appointment to see a cardiologist in the next few weeks.

Did the cardiologist panic?   Yep.  Did I panic?  Yep.   The alternative was too scary to contemplate.

2 thoughts on “Treat the test or treat the patient?

    • Yes, this is absolutely true!! But try telling that to our patients who insist on getting tests, thanks to what they see on Oprah or Dr. Oz.

      Thanks for reading!

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