Staccato comments on cardiovascular disease
Heart attack – Most common reason is blockage but not every time.
Angina is progressive blockage that is causing heart attack.
EKG often times cannot show a heart attack. It shows 60-70% of time but not 100%. You don’t wait for the enzymes to go up in an emergency. Many times the blockage is like a jello and rarely it is like a complete block. Their catheter can sometime go through jello rather than get blocked.
Right coronary artery – while walking goes away – then it is not…It seems like indigestion.
Balloon opening to deliver a stent.
Typically cardiac arteries are stented when there are 70% or more blockage… Not every narrowing is fixed.
Bypass – hook a vein to let the blood flow.
Stents – different sizes. So number of stents don’t mean much…
Heart attack– stemi – blood stopped. Cardia arrest – heart beat stopped.
50% of people who die from heart attack before reaching hospital. Most succumb within 1 hour.
Approx 30% of all first heart attack are fatal.
Chest compression 100 per minute is required in first place for a patient to recover
Right coronary artery – caused heart attacks can be fatal. AED can be helpful.
Cardiogenic shock – is the worst presentation of heart attack who did not die.
Atherosclerotic disease – no1 cause of death, 2- stroke 3- COPD 4-lower lung respiratory 5 -lung cancer and 6- alzhiemer’s dementia.
Inflammation is the cause. It causes atherosclerotic areas to build up.
Risk factor that are not modifiable – Age, premature family history, Gender. (Men 45 yr and Women at 55)
Modifiable: Hyperlipidemia, hypertension, diabetes, obesity, stress (depression), physical inactivity, excess alcohol consumption, diet,
60% of US population is obese.
Alcohol raises HDL – 5 types and it does not raise for all HDL types.
Best diet – vegan, second mediterrean, – Denordish program – has been shown to hold coronary heart disease. Bill clinton did it ???
Emerging risk factor – metabolic syndrome, sleep apnea, inflammatory conditions (Psoriasis, RA, lupus, HIV), air pollution, CKD, Elevated lipoprotein A, Erectile dysfunction.
LDL – Show the score that is averaged over one month. goal less than 70, high risk less than 55, extreme risk less than 40.
Safety is excellent even with levels less than 25 (LDL), no excess hemorrhagic storke, cancer, or cogntive decline – STATIN’s work
With LDL less than 55, the blockage may reverse.
Plaque stabilization is important: STATIN may do that…
Cardiac CT calcium score can show artery issues of atherosclerosis. Calcification score over 400 – maybe more likely to be have a blockage. If you are athelic person – their calcium score goes up…then the calcium is extraluminal …in those patients a high calcium score is acceptable though for other patients it will slowly progress
HDL : High is bad (>90) since it may represent non functional HDL. HDL <40 is bad.
Tricycleride – goal less than 150 (could change from day to day)
Blood pressure: Should measure first thing in the morning before stresses and coffee.
Goal is 130/80 or less. If you have atherosclerotic disease.
Over age 79 – 140/80.
USA and European guidelines differ for stage of hypertension.
A1C – is 3 months worth of sugar – ideal less than 7, If you have a risk for hypoglycemia – then <8.5.
SGLT2 inhibitors: Farsiga and Jardiance…Management of Cardiavascular disease too.
Renpatha (pcsk9) and statins also help by keeping inflammation low.
– Doc realizes that he is extending life for quality of life rather than only extending life.
Afib – 80% not felt. Afib is to present
Autonomic dysfunciton – bp can drop.
Useful life to stent?– Medicated stent – 5% in the first year…after that it is very low. Stent over 10 years.
Vein bypass – intimal hyperplasia – because vein does not have any muscle. Over time – 1st year is the max…5 year – 30% over 20 years
Radial artery – 20 years – 85% still functional.
Surgery over stents if your are diabetic and if you are a woman.
50-60% – statin drugs also work for inflammation.
Pcsk9 – also does the same.
Plaques keep forming – and solidifyng and then forming and then decreasing and solidifying
Colchine – Can be used to lower the risk of arterial disease and also lowering the plaque formation. 0.5 is the one that is approved in the clinical study, and therefore 0.6 is the one is usually that is given.
For inflammation – usually CRP score is used, but also IL1 and IL6 could be the ones that would be used.
