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Diet patients asking: Do they need heart tests?

September 24, 1997

WASHINGTON (AP) _ Anxious dieters, fearing heart damage from drugs pulled off the market last week, are flooding a telephone hot line and showing up at doctors’ offices demanding echocardiograms.

But peace of mind could be elusive. The tests are expensive, and physicians say they’re probably not worth it for patients who have no symptoms.

``There could easily be an onslaught (of demand). We’re worried about that for sure,″ said Dr. James L. Weiss, who runs the echocardiology lab at Johns Hopkins University. ``By no means are we recommending that everyone who’s taken one of these diet drugs have an echocardiogram. If that happens, we’d be doing nothing else in the lab.″

But for patients such as Annemarie Stokes of San Diego, an echocardiogram could explain worrisome symptoms, like severely swollen ankles or the tightening and tingling in her chest and arms when she coughs or breathes deeply.

The problem: The uninsured student can’t afford the heart test, which can cost $800.

``I may be facing ... (the possibility) I was really a victim of these stupid pills I took,″ said Stokes, who is 5 feet 6 inches tall and weighs 300 pounds and took Redux for three months until, out of money and ill, she quit. ``I may be suffering from something that could be fatal, and I can’t even go and check it out.″

Redux and fenfluramine _ the first half of fen-phen _ were pulled off the market last week after doctors discovered they could damage heart valves. Patients short of breath and suffering other symptoms were reported in July, but then the Food and Drug Administration found evidence that 30 percent of dieters with no symptoms also might have valve damage.

The FDA advised dieters to immediately stop taking the drugs and see a doctor. But the agency couldn’t say who needs an echocardiogram, a sophisticated test that lets doctors watch a patient’s heart valves open and close.

Why? Nobody is sure whether patients with no symptoms but minor damage detected by the sensitive test are actually at risk. There’s no treatment for valve damage _ heart surgery is only for the severely ill. The main advice is for valve patients to take antibiotics before any dental work, to keep unearthed germs from infecting the vulnerable valve.

But worried patients are seeking advice _ 175,000 have called a hot line run by the drugs’ maker. And several doctors around the country say they have seen an increase in demand for echocardiograms, and worry the demand could grow.

Dr. Robert H. Eckel of the American Heart Association is helping a medical coalition draft treatment guidelines. His advice: People with no symptoms and no heart murmur do not need an echocardiogram. Instead, they should see their doctor every three to six months for monitoring.

``Unfortunately the amount of information on what to do is limited at this time,″ said Eckel, who treats patients at the University of Colorado Health Sciences Center.

He told one frightened woman that ``the test is available and I can’t keep you from getting it.″ But once she learned the cost and the questions, ``she did not force the test. I’m going to see her again in a couple of weeks.″

Testing can offer peace of mind. ``We’ve had some patients who had normal studies, and they appear to be relieved,″ said Dr. John Gottdiener of Georgetown University.

But how do doctors differentiate between the patient who took fen-phen for 12 months five years ago and one who took it for six weeks last year? asks Dr. Arthur Frank of George Washington University. ``It’s an enormous problem for us,″ he said.

Diagnosing echocardiograms is tricky. The drug damage shows up as fibrous lesions on the edges of aortic or mitral valves, keeping them from closing all the way. That can let blood leak back into the chamber that just pumped it out, forcing the heart to beat harder and harder until, over time, the muscle becomes too enlarged to work properly.

But valves degrade with age. They also can have harmless variations, so what might be just a slight thickening that a person was born with could be interpreted as drug damage.

``The biggest impact we’ll have are dealing with people’s fears,″ Gottdiener said. ``Some readings are going to panic some patients.″

For those who do have damaged valves, ``all you can offer them is the truth,″ said Hopkins’ Weiss. ``If something is found, it probably warrants follow-up. How often, I don’t know.″

___

The toll-free hot line is 1-800-892-2718.

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