When endurance athletes have “hearts of stone”


I have just returned from attending a course on the “Prevention of Sudden Cardiac Death in Athletes,” hosted by the University of Washington medical school in Seattle.  It was a terrific conference at which academic leaders in the field gave updates on the latest research.

Dr. Aaron Baggish, from the Massachusetts General Hospital in Boston, summarized two recent studies that have persuasively shown that coronary calcifications are more common in long-term endurance athletes compared to more sedentary controls.

When the studies were published this past summer, Dr. Baggish was asked to write an editorial commentary to share his perspective.  That editorial was provocatively subtitled “Hearts of Stone.”  The phrase refers to the appearance on CT scans of hearts with heavily calcified arteries as shown in this image:

Calcium in coronary artery detected by CT scan.
Image attribution: Wikimedia Commons


In the last several years, a few reports were published suggesting that endurance athletes may be more prone to having build-up of plaque and calcium in their coronary arteries.  Those reports presented a paradox, because we also know beyond any doubt that regular, moderate level exercise promotes cardiovascular health and longevity.  The studies raised the concern that exercise could be harmful after a certain point.Read more

Are statin drugs over-prescribed?

Your heart health in a heartbeat – Episode 1

If your cholesterol is high, should you immediately start lifelong medication?  Join me as I discuss a new study which addresses this important question.

Link to the study discussed in this episode:

Implications of Coronary Artery Calcium Testing Among Statin Candidates According to American College of Cardiology/American Heart Association Cholesterol Management Guidelines

Related blog post about the heart scan:

The heart scan as a “mammogram of the heart”



The echocardiogram: seeing with sounds!


Ultrasound technology is not exactly new, but it never ceases to amaze me.

First developed in the 1950’s, medical ultrasound technology uses the fact that different tissues and fluids in the body reflect sound waves differently.  If an ultrasound source is applied over the chest, the sound will be reflected back from different parts of the heart in a way that can be analyzed to reconstruct an image of the heart in real time.

"Ventricular Septal Defect". Licensed under Public Domain via Wikimedia Commons.

Licensed under Public Domain via Wikimedia Commons.

Because of the clarity and reliability of the image produced, echocardiography has become an indispensable tool of cardiac diagnosis and has allowed doctors to “see” directly what they previously had to imagine, deduce, or guess: the size of the heart chambers, the pumping strength of the heart muscle, the health and function of the heart valves, the presence of fluid build up around the heart, the size of the aorta and other major vessels, and many other important cardiovascular features.  Having all this information at the tip of our fingers would have been unimaginable to cardiologists of a generation or two ago.

What’s more, the procedure itself—as far as the patient is concerned—is completely safe and painless.  The technician applies some gel on the chest, which allows the ultrasound probe to have better contact with the skin.  The probe itself is like a speaker and microphone in one piece, transmitting and receiving the sound waves which are immediately analyzed and displayed on a monitor.

Of course, there is a great deal of skill involved in obtaining good images.  Because the heart is surrounded by ribs and lung tissue which interfere with the ultrasound images of the heart, one must find adequate “windows” to take a peak at the heart.

The procedure for a complete echocardiogram takes about 30 minutes or so.

Introducing the Coronary Health Starter Kit!


Dear Friends,

In an effort to make heart scans more widely available, I am delighted to introduce a new service:  AHSF’s Coronary Health Starter Kit.

This service consists of an affordable telephone consultation focused on a cardiac prevention.  As part of this service, I order the famed “mammogram of the heart“, the coronary heart scan that can detect the presence of coronary artery plaques in their early stage, before they cause complications such as heart attacks and sudden cardiac arrest.

I recommend this service for men over age 40 and for women over age 50 (or younger women  if they had premature menopause).  You may consider obtaining the service at an earlier age if you have strong risk factors, such as a family history of coronary disease at a young age. This is a screening service, so it assumes that you feel generally well and have no specific symptoms to report.

I cannot think of a better investment for your heart health than to take advantage of this service and obtain a heart scan.  Please do not delay.  It is as simple as picking up the phone and calling 1-415-567-1014 between 9a-3p to make time for a telephone consultation.Read more

The “mammogram of the heart”


The phrase “mammogram of the heart” refers to the heart scan that detects calcium build-up in the coronary arteries.  The phrase was coined by the pioneers in this technology to try to impress on the public and on the medical community the simplicity and value of this test.

Calcium in coronary artery detected by CT scan.Image attribution: Wikimedia Commons

Calcium in coronary artery detected by CT scan.
Image attribution: Wikimedia Commons


Just as a mammogram can identify cancer before it spreads, a heart scan can identify the presence of coronary artery disease before it causes symptoms.  And like the mammogram, the heart scan is easy to perform, uses a low amount of radiation, and is inexpensive.Read more

Demystifying the cardiac stress test


For most people, the cardiac stress test is the epitome of modern cardiology.  For some, the thought of undergoing one may also cause cold sweats…Perhaps a little introduction can help clarify what it is and what it does, and will minimize any misplaced fear about this helpful diagnostic tool.Read more

Q&A about high blood pressure during exercise


Please note: this article is for general information only and should not be taken as specific medical advice. Should you have any symptoms or concerns, please seek medical attention or contact us for further evaluation. If you feel you are having a medical emergency, contact 9-1-1 immediately.

Image attribution: www.volganet.ru CC.BY.SA.3.0

The adverse effect of lack of exercise on the blood pressure is well known.  A sedentary life frequently leads to chronic hypertension, and in turn, high blood pressure can lead to heart, brain, and kidney damage.

We will address the topic of chronic hypertension in a separate article.  Today, we will discuss a phenomenon called “hypertensive response to exercise” which can occur in seemingly healthy subjects who have no history of hypertension but whose blood pressure during exercise seems to increase “too much.”Read more

Demystifying the ECG


ECG pulse trace

Image attribution: via Pixabay Creative Commons CC0 Public Domain

The electrocardiogram (ECG) is by far the most commonly performed cardiac test.  You may have seen a picture of one in a book or a magazine, or you may have been drawn into the drama of this mysterious waveform, flashing periodically on a monitor during a tense moment of  “E.R.” or “House.”

Have you wondered what the ECG is truly about?

The following Q&A will demystify the test as we begin to reflect on how the heartbeat comes about.Read more

Facts and nuances about cardiac screening


We are delighted to have been featured in a San Francisco Chronicle article which highlights the rising interest in cardiac screening among athletes.  I was correctly identified as being among the growing number of cardiologists who believe that current screening tools are excellent and underutilized.

The article covered the subject of screening in general, so I would like to offer some additional information for clarification. Read more

Is the ‘Google Pill’ the only hope for heart disease detection?

There has been a great deal of buzz around Google’s announcement of their plan to develop a “pill” that will circulate in the blood stream to detect early forms of cancer and give warning signs about impending cardiac complications.  Thissounds like science fiction, but who knows?  We certainly wish them the best success in this endeavor.

But do we really need to wait for these futuristic projects to be able to detect heart disease early?  I wrote an Op Ed for the San Jose Mercury News which you may find informative.