As readers of the blog may know, I have been a very strong proponent of the coronary calcium scan for many years. The scan is a great tool to help determine vascular health and make a decision regarding the treatment of high cholesterol.
I have argued in previous blog posts and videos that patients with a coronary calcium score of zero may be able to avoid medications to lower cholesterol. In the last couple weeks, 2 news items from the cardiology community have bolstered my opinion.Read more
A gym in our neighborhood has a big sign that challenges the passerby to “Make your body your machine.” Another one a few blocks away entices potential customers with a poster that says “We don’t use machines. We build them.”
These are clever and funny points. There is certainly a sense in which bodies are like machines, with parts that work on each other to accomplish things. And, for all practical purposes, those parts can be described the same as engine parts: There is a fuel system (digestion and metabolism), a plumbing system with a pump (the heart and blood vessels), an electrical system (the nerves), a system of pulleys and joints (the muscular system), etc.
But the metaphor can go a little too far.Read more
We are pleased to announce the addition of the “carotid intima-media thickness” test (CIMT) to the array of non-invasive diagnostic tools available at Athletic Heart SF.
The idea behind the CIMT is simple: an ultrasound image of the carotid artery can provide information about the health of the artery itself and, more generally, about the overall health of the cardiovascular system.
The ultrasound image can identify two conditions. First, the ultrasound can detect if there is actual plaque build-up which, if advanced, can block the flow of blood and contribute to the risk of stroke. Fortunately, advanced plaque build-up is relatively rare.
Second, even in the absence of plaque build-up, the thickness of the vessel wall (CIMT) can give a broad indication of cardiovascular health. The intima is the name of the inner lining of a vessel wall, and the media is the middle layer. Both are seen in the image below as the bright thin line and the thin darker band behind it.
Ultrasound image of a carotid artery. The thin intima-media layer is indicated by the arrow.
Dr. Larry Creswell recently wrote a blog post summarizing the excellent research work that he and his colleagues have conducted to better understand the causes and conditions of death during triathlon events.
They have identified all triathlon fatalities that occurred during a 31-year period (1985-2016) and analyzed as many of the relevant factors as possible. Their work was published in the journal Annals of Internal Medicine.
They observed the following:
In many cases of non-traumatic death, preexisting heart or vascular disease was discovered at autopsy. The article notes that:
“A surprising and important observation of this investigation, on the basis of autopsy reports, was the high frequency of clinically silent cardiac abnormalities (present in about 50% of the cases with an autopsy report available) that may have caused or contributed to sudden cardiac death.”
Dr. Creswell recommends that athletes should consider their heart health before participating. Middle-aged men in particular should consider undergoing cardiovascular screening ahead of the event. Read his excellent blog here.
-Dr. Accad
Discover Our Unique Cardiovascular Health Services!
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
LINKS:
Cardiac arrest during marathons: 10 facts to consider.
Study of triathlon deaths concludes more screening is needed.
Interesting research studies from the American College of Cardiology 2016 meeting.
TRANSCRIPT:
Hello everyone,
There has been bad news coming from the marathon and triathlon communities regarding cardiac deaths during these events. At the London marathon, a middle aged man suffered a cardiac arrest, and in Canada, a few days ago, a middle-aged woman also had a cardiac arrest and died during the swim portion of a triathlon.
So I thought I would take a few minutes today to go over what we know about cardiac arrest at these endurance events, and then go over some new recommendations for screening that were proposed at a recent meeting of the American College of Cardiology.Read more
Again, Athletic Heart SF is delighted to have participated in a screening event for school kids age 12-18 that took place on January 26, 2016, at Sacred Heart High School in Menlo Park. The event was organized by Via Heart Project, and the kids also received instructions in basic CPR.
A total of 535 kids were screened, a 3 were found to have conditions that put them at risk of serious cardiac complications. Others were also found to have some structural anomalies of the heart or aorta that would need further follow-up.
If you think your school district could benefit from a screening and would like to get involved, I encourage you to contact the non-profit Via Heart Project organization. Also, don’t forget that the availability of AED is essential to increase survival rates in case of cardiac arrest. If your local school is not properly equipped, Via Heart also helps with that.
Mammograms, PSA tests, heart scans, lung scans are all subject of debate and controversy. Why is that? Join me as I clarify the reason why screening should not be viewed only from the perspective of public health,
Transcript
Today, I’d like to talk about screening tests in general and why there seems to be so much debate and confusion about them. It seems that every other week there is a new report in the media raising doubt about the value of this screening test or that screening test, whether it’s mammography, the PSA test for prostate cancer, colonoscopy, heart scans, or what have you. And you hear one group of people advising one way and another advising another way, and it’s very confusing.
So how do we make sense of that?Read more
I had the pleasure of being interviewed by Sami Karam, the editor of Populyst, an economics and demographics blog and podcast. Sami heard about Athletic Heart of San Francisco and decided to devote a show to the topic of heart screens. We covered a lot of ground, but the focus was mainly on detection of coronary disease and on contrasting the early detection strategy to the strategy of managing risk factors. I hope you will find our conversation informative. To listen to the podcast, simply click on the play button below or on this link.
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
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
