DEAR DR. ROACH: We just learned that a 30-year-old woman who was six weeks pregnant with twins had a heart attack during a spin class and is now lying in a coma in the hospital. The woman was then diagnosed with a congenital heart defect.
Other than insurance companies balking at paying for imaging, is there any medical reason for OB-GYNs not to schedule such a test for women with a family history of cardiac problems? — A.S.E.
ANSWER: I couldn’t find the news story that you are referring to, but congenital heart disease in adults that leads to heart attacks is quite rare, but not unheard of. Currently, newborns are screened by pulse oximetry for congenital heart disease, but since this screening recommendation started in 2011, a 30-year-old would not have gotten screened. This screen is very good, but not perfect, at finding congenital heart disease in newborns.
Having an unrecognized congenital heart condition at age 30 would still be very uncommon (90% of congenital heart disease is recognized early), and a general history and physical exam should identify most conditions. There aren’t any guidelines that I could find to screen adults for congenital heart disease.
The reasons why it isn’t recommended include that the condition is rare, but also that a trial of screening the entire population for structural heart disease (congenital and acquired) didn’t find any benefit. Finally, there is the risk of a false-positive in screening tests (such as an echocardiogram), which might require invasive further testing (such as an angiogram) and has the potential for serious injury, including kidney failure and damage to the arteries.
The issue is different in people with a family history of congenital heart disease because the likelihood is much higher. In this case, I don’t know if there was a family history, but consideration of screening for family members should occur as soon as one case has been identified.
DEAR DR. ROACH: Our now-retired former general physician told my husband and me about the latest research stating that taking high blood pressure medication (such as our benazepril) and thyroid medicine (Synthroid) is most effective between 1 and 3 a.m. We have followed this advice for almost 10 months, but wonder if this is actually better for our health.
Before this, my husband took Synthroid every morning for nearly three decades without any discernable problems. — J.K.
ANSWER: A 2020 study suggested that better outcomes occur when taking blood pressure medication at night, but additional studies did not confirm this finding. The best recommendation now is to take the blood pressure medication at any time that is convenient for you, as long as it is the same time every day.
Thyroid medication absorption can be affected by some foods (especially caffeine-containing ones) and medicines (especially calcium and iron supplements), so many experts recommend avoiding these within 30-60 minutes of taking thyroid tablets. However, if your husband has been taking it for decades one way, and the levels in his blood are always good, then he should keep doing what he’s doing. Consistency is the most important factor.
In my opinion, waking up at 2 a.m. just to take medicine probably does more harm than good.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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