Heart scan curiosities 2

9. December 2006 William Davis (2)


This is an example of a so-called "hiatal hernia", meaning the stomach has migrated through the diaphragmatic hiatus into the chest--the stomach is literally in the chest. This example is an unusually large one. Hiatal hernias can cause chest pain, indigestion, and a variety of other gastrointestinal complaints. Heart scans are reasonably useful to screen for this disorder, though very small ones could escape detection by this method.

Sometimes, you can actually hear the gurgling of stomach contents (the common "growling" stomach) by listening to the chest. Large ones like this actually crowd your heart (the gray structure above the circled hernia), irritating it and even causing abnormal rhythm disorders. The dense dark material within the hernia represents lunch.

I would not advocate CT heart scans as a principal method to make a diagnosis, but sometimes it just pops up during a heart scan and we pass it on to the person scanned.
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Comments (2) -

  • Anonymous

    8/2/2007 5:42:00 PM |

    Awesome, just awesome.Brilliant blog that has helped me ALOT so I am eternally grateful. Phil

  • Anonymous

    10/4/2007 2:01:00 AM |

    I just had a heart scan. 44 year old female with family history of heart disease.  Both parents in 40's with heart attacks/by-pass surgery...My cardiologist ask if I had ever been diagnosed with a hiatal hernia and the scan looked somewhat like the one you show.  It looked like I had one Big Heart!  He told me to follow-up with my PCP.  I did, he is new for me and not sure I see eye-to-eye with him, but he insist a hernia can not show up on a heart scan, I told him, I saw it, I saw the scan, I saw the white circle...I have had GERD for 5-6 years now, nausea almost every morning on top of the reflux in the morning and my family always complain how long it takes me to eat! Guess what, I'm having an upper GI in the morning.  Thanks for this information...I thought maybe I was loosing my mind!

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Damage control

Damage control

15. December 2007 William Davis (5)
Medical device manufacturer, Cordis, is launching a new marketing program to promote its Cypher drug-coated stent. You can view the details at www.CypherUSA.com , including the slick TV commercial that HeartHawk posted a blog about.

The campaign opens with:

When you open up your heart, you open up your life.

Lives hampered by angina. By shortness of breath. By restricted blood flow. These lives are changing. Because of a state-of-the-art advancement. One that can have a huge impact on arteries around your heart. The CYPHER® Stent. It can open up your arteries. Increase flow of blood and oxygen. And change your restricted life. To an active life worth living. Your new life is...

Life Wide Open


Direct-to-consumer drug advertising has been around for a few years. While it has increased awareness of drugs and the "conditions" they are supposed to treat, it has also highlighted the aggressive profit-motive of the drug industry. This is not health care for the needy and sick, but health care for profit.

So now we're beginning to see the emergence of direct-to-consumer (DTC) advertising for medical devices. There was also a brief, though unsuccessful, foray into DTC advertising for implantable defibrillators, of all things, by Medtronic a couple of years ago, also.

What is the purpose of Cordis' marketing effort? Is it to educate and inform the public who might unknowingly receive non-drug coated stents and be deprived of the restenosis-inhibiting advantage of a drug-coated device? Is it meant to right a systematic wrong, a failure of cardiologists to insert the technologically, biologically, and ethically superior coated stents?

I find that doubtful. A more likely motive is damage control. With some of the (both deserved and undeserved) negative press the drug-coated stents have received lately, Cordis, eager to protect their $20 billion (annual revenues, 2006) medical device franchise, came up with this DTC strategy. After viewing the smiling faces of people , elated because of their "wide open" arteries and lives, Cordis hopes to see people going to their doctors insisting on the stent that is "opening millions of lives," since, "when your arteries narrow, so does your life."

Cool, trendy, liberating. That's the message they wish to deliver. Cool music, beautiful people, flashy high-tech images. Who wouldn't want a Cypher stent?

Beyond damage control, it's a familiar marketing theme: You're slender, glamorous, and sexy if you drink Coke, you're a caring mother if you feed your children Jif peanut butter, you're health conscious and smart if you eat Total cereal . . . you're cool and know what you want from life if you insist on a Cypher stent.

I don't object to advertising. It's part of the capitalistic economic system. It drives awareness and grows businesses. I do get concerned when advertising is so slick and effective that the people who are not properly armed with information can be duped into thinking that they need something that they don't really need.

Or, for which there are powerful, viable alternatives. Even hear about "prevent the disease in the first place?"
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Comments (5) -

  • Sue

    12/16/2007 1:59:00 AM |

    "Prevent the disease" - it will affect the profits - lets make sure the disease takes hold and progresses!!  For just $999 (first instalment) you too can have your very own stent - limited lifetime guarantee!!

  • jpatti

    12/16/2007 2:20:00 PM |

    Do people really do this?  I can see going for a checkup and asking for a particular medication, but is someone in a cath lab being prepped for surgery really gonna ask for a particular brand of stent?

  • Dr. Davis

    12/16/2007 2:29:00 PM |

    Yes. I've actually been asked that question a number of times.

  • Anonymous

    12/16/2007 10:15:00 PM |

    I agree with your comments. Three months ago I had an overly aggressive cardiologist put 5 Cypher stents in me. My current, new cardiologist says that I only needed one and wants to do another angiogram in 3 months (6 months after the procedure) to check for scar tissue. Is that unusual?  I am getting wary of medical procedures.

  • Dr. Davis

    12/17/2007 2:16:00 AM |

    Without knowing full details of your case, it's not possible to say with absolute confidence what is going on. However, it is highly unusual to perform a "routine" repeat catheterization to check for scar. That is not a standard reason for heart catheterization. The same information can nearly always be obtained by less invasive means, such as a stress test or echocardiogram.

    I wonder if it's time for a 3rd opinion.

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