Very few medicos, much less patients realize that the word investigation comes from vestige, which means a mere trace of a phenomenon. Rang of Canada described investigations as a medical mischief that has the power to convert a person into a patient. No wonder, a Check-up Clinic is a special area where a person walks in, and a patient walks out.
All investigations in CAD-n-HA (Coronary Artery Disease and Heart Attack) strive to get data on artery, blood or heart. Everyday there is new investigation into the market and the list is endless. However, there is no investigation that can say whether the patient with the bad report will die or the doctor with his good report will survive. Nor is there any way of finding out which heart will develop a heart attack and when. Investigations make all of us learned but fail to help the patient or the science of CAD-n-HA itself. Needless to say that the investigations fall into biochemical, immunological, electro-cardio graphic, images, techniques and radioisotope studies.
ECG or Electro Cardio Gram - this is a static recording of a dynamic process. It provides the then state of the heart but beyond that it is unreliable. The ECG of a person at 9.30 am is invalid for the next heartbeat less than a second away. That is why the surprising but quite natural heart attack or death therefrom, following a perfectly normal ECG. The technique of obtaining ECG is called electro-cardiography and the machine for that is called electrocardiograph. The Halter technique is a way of obtaining a continuous 24 hrs. ECG recording of a person or a patient during rest or exertion. It has poor predictive value.
An eminent cardiologist of Mumbai had declared that the ECG machine had done more harm than the atom bomb. Christiaan Barnard, the famed surgeon of South Africa, who did the first heart transplant in humans, saw ECG as an "electrical squiggle transforming happy individuals with a purpose in life into frightened, unhappy creatures of despair". Harrison the famed editor of the textbook of Medicine named after him concluded at the end of his life that doctors suffered from ECGitis and heaven help their patients.
Echocardiography (2D echo, Doppler)
There is one investigation that bears a special mention here for its simplicity and its routine use. Echocardiography (2D echo, Doppler) provides structural and functional data on heart muscle, valves, and blood flow. The most useful component of 2D echo is EF or LVEF which gives a good measure of the power of the important left ventricle of the heart. The echo can show poorly functioning parts of the heart, usually referred to in the report as RWMA, standing for Regional Wall Motion Abnormalities
Stress test or Treadmill
Stress test or Treadmill asks a person or a patient to do exactly what ordinarily he is asked by cardiologists not to do, that is, to strain his heart to the point of registering an abnormal ECG. The stress test is yet to prove its reliability in terms of what will happen to a normal or a damaged heart.
Often abbreviated as CAG (Coronary Angio Graphy) and spoken of as Coronary Angiography. The process involves puncturing a major artery to allow entry of a catheter. There is distinct damage to the punctured artery with all the attendant complications. The catheter travels a distance of 2 to 4 feet before reaching the coronary vessels. During its travel, the catheter can hurt many arteries. The x-ray dye injected into the coronary tree gives a picture of arteries away from the heart muscle. Hence, the real truth about the blood supply to the heart muscle is not obtained.
The circuitous nature of coronary arteries fails to give a reliable picture. The number and the size of arterial blocks on CAG vary from doctor to doctor. Heart specialists are prone to over-read the blocks before invasive treatment, and under-read the very blockages that occur as a result of invasive treatment. As yet, CAG is both unreliable and misleading