Heart MOT in French

Greetings

So I’m coming to the age where my father had a heart attack (he survived and given a stent) and I was wondering what a heart MOT is called in France as I would like to have one.

TIA.

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To start with probably a CT :blush:
And whilst on the subject of CT, a CT angiogram (x ray) will show up any narrowing of arteries around the heart. A cardiac calcium CT only shows calcium build up.
Over to the others

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Right Control Technique lol…so just want to find a way of having one via Doctor Lib.

Do you have a Medecin Traitant? if so, discuss with him/her and they will write a letter of introduction to the cardiologue of your choice…

The equipment available is amazing (well, it impresses me… ) OH has been on/in/under all sorts of machines.

Me, I’m due for an echography… which will be fun to watch… seeing my heart and all its bits… working well (I hope).

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You ask MT for a “bilan cardiac complet”, and he/she will do basic tests and then with family cardiac history will most likely give a prescription and referral for a cardiologue. Which you book directly, but be prepared for a wait. The cardiologue will then do the necessary.

Presumably you have learnt from your father so are looking after your heart more carefully?

If your MT doesn’t know already take along details of your family history and your father’s heart attack.

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Yes, I should have said… while it is the MT who writes to the Cardiologue… it will be up to the Cardiologue to decide what tests to undertake…

My Doc has suggested to me that it will be an Echography… but I know the Cardiologue very well (due to OH’s problems) … and am happy for her to choose what she wants to do and how she wants to do it… :wink:

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Thats trusting, with the NHS I usually insist on certain tests and scans as it appears they often use the cheapest and easiest to book. France seems different.

From what you say about UK… and from my own extensive experience here… I would say France is different… very different indeed.

Hi

Firstly in a generation the management of risk factors has improved significantly. Smoking was a lot more prevalent in his age group and much less in ours. Type II diabetes is increasing but much more rapidly recognised and treated. Blood pressure and cholesterol control are also now the norm. If you don’t smoke aren’t diabetic and have a reasonable cholesterol and your blood pressure is OK and your profile photo wasn’t taken 20 years ago your risk is modest!

If your father didn’t smoke he may have had a high cholesterol which can run in families but being in France it is almost inconceivable that with the Gallic love of blood tests that has not been measured. If not that is step one.

Cardiac imaging is a contentious issue and until recently largely done for profit without a great evidence base. Calcium scanning is even more contentions and has an event thinner evidence base. Non invasive tests are lower risk but less sensitive. Cardiac CT has been improving but scanning something moving, even if you gate the pictures to an ECG like synchronising your machine gun to fire through the propellor of your Fokker Triplane, is suboptimal. Full coronary angiography through a small catheter inserted in the arteries is the gold standard but invasive and with some small risks. They are more than balanced by the benefit if you actually need treatment.

If you have reason to be concerned echocardiography (an ultrasound of the heart) and stress ECG would be all most would consider necessary. Legging it uphill on a treadmill for 9 minutes whilst wired up to an ECG is good enough for NASA and the Civil Aviaition Authority to allow older people to be in command of commercial flights. An ultrasound of your carotid artery to look at Initmal Medial Thickness, is a good marker of whether you are starting to form early arterial disease and hence to consider more aggressive risk factor (mainly cholesterol) management.

My old man had his coronaries bypassed at 59 so I started a statin 5 years before that. Bear in mind that they are not as bad as some elements of the press would have you believe. The incidence of real side effects is around 3% but if you give people a placebo and tell them its a statin 60% will get them! Misleading publicity has given rise to a new phenomenon the “nocebo effect”.

Regards

Andy

Do so like them, not invasive and get to hear my heart whooshing away in the same way it has done for years which is reassuring.

Now I have wondered about that, a small catheter is a lot more rigid than a blood cell etc so it must surely scarf off the glycocalyx on it journey and possibly damage the endothelium?

My CT calcium scans software must have been pretty good as the image quality was excellent.
No sign of motion blur etc. That was a few years back and so I would like my GP to book a CT angiogram to see if anything else may be starting to occlude anywhere important.

Issues around cholesterol seem to be the subject of discussions on going without an absolute definitive answer. FH people still live good lives and the lean mass hyper responder pheno type have in many cases very very high LDL cholesterol but after all the scans very low to zero atheroscelrosis. All very interesting.

Likewise the increased cardiac deaths since 2020.

I hope my cardiologists was careful enough not to actually damage the endothelium, it seemed to travel very smoothly. And yes fun to watch, but it hurt like f*#@. Apparently I have delicate arteries.

The glycocalyx is incredibly easy to damage, one of the main reasons they only recently discovered it. Fortunately it is so important that if things are good it regrows. There are companies now selling suppliments to aid if things are not so good.

Anything lightly touching the endothelium, even a tiny angiography catheter will cause localised minor damage at a cellular level, but it will regrow in 48 hours and is unlikely to be of any clinical significance. If you poke off a chunk of calcium (usually whilst going in through a diseased access artery) or other crud that is clearly a different matter and have spent many happy hours in the last 40 years fishing that (and displaced closure devices) out of legs with a balloon for my cardiology and radiology colleagues.

You want to know if anything is occluding? If it is and it is not causing symptoms would you be keen to do anything invasive about it? An abnormal functional effect as demonstrated by ischeamia (shortage of a decent oxygenated blood supply) on a stress ECG is probably of greater value. I remember being taught by a wise old Radiologist in the late 70s that “we treat patients not X-rays”!

Major caveat however is that, as a plumber, I do the pipes not the pump.

And have been referred to as the Forrest Gump of vascular surgery.

Same disease though.

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Thanks, yes appreciated the use of doppler ultrasound flow tests for blood supply, I was thinking more along the lines of CT angiogram with contrast dye rather than an invassive proceedure.
Reading Dr Malcolm Kendricks book “The clot thickens” gives a fantastic insight into all things circulatory.

I am typing this from my recovery room in a cardiac unit after yesterday’s procedure, so I claim the prize for contemporaneity. I was referred to cardiologist after many months of stubbornly high blood pressure not responding to several different combinations of pills - no other signs or symptoms, such as chest pain, although I personally thought that leg muscle weakness was not necessarily a coincidence. The cardiologue sent me first for coronascanner, which showed a massively high presence of obstructions in the coronary arteries. (So why no massive symptoms ???) Nine days later the procedure was a coronarography, which evolved (on the table) into a angioplasty - i.e. not only better identifies what needs to be done, but gets on with the repair job there and then. That one tackled the most affected artery, and the same procedure yesterday got on with two others. First was painless, not so yesterday, but not a reason not to do it. The procedures are indeed without general anaesthetic. In parallel, and ongoing, the cholesterol treatment is much increased, including, but not only, statins. How to get all this great treatment ? - get referral letter from your MT, go on line to Doctolib/cardiologue, and hope you are in a good area. Good luck to all in the same boat.

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glad to hear it has all gone well !!!

Glad you are doing well Arthur and thank you for a new word. Contemporaneity.