We have a lot of questions about heart. Here is an attempt to answer a few of the questions. Actually this is just a collection of answers provided by Senior Interventional  Cardiologist Dr Deepak Krishnamurthy on Twitter.  Follow him: @DrDeepakKrishn1. I have now added Additional Notes, which are my additional notes gathered from the Web.

 

Information is provided here to help understand your condition. Always, always seek proper medical guidance.  Your condition will be different. A doctor should understand your condition and guide you. Hope these answers help you to seek early medical advice and intervention. 

 

Please note I have added a few additional information from other sources or made some additions to understand the tweet better. These are in ITALICS. Please note headings and subheadings have been added for easier readability and access. 

 

What is a Heart Attack?

What is a heart attack? - the arteries supplying the heart muscle develop deposits of cholesterol forming "PLAQUES" which can rupture and develop a blood clot causing obstruction to the flow of blood to the heart muscle. Treatment is angioplasty or an injection to dissolve clot.

 

Risk factors

Risk factors for heart attack 

1. Diabetes Mellitus 
2. Hypertension 
3. Smoking 
4. High cholesterol 
5. Obesity 
6. Hereditary factors 
7. Stress 
8. Pollution 
9. Sedentary lifestyle 
10. Bad dietary habits

Prevent Heart Disease and Stroke

 

 

Know your numbers

BP - 120/70-130/80 

Fasting sugar - below 110mg/dL 

HbA1C below 7% 

LDL cholesterol below 100mg/dL 

Ideal Weight - height in cm minus 100

Waist circumference less than 50% of height

 

Important numbers to keep handy

1. Ambulance 
2. Your doctor 
3. Nearest hospital with Cardiology  facilities

Cardiac Arrest vs Heart Attack

 

 

Golden Hour

The #goldenhour - the earlier one gets to hospital and flow is established in the blocked artery in a heart attack the better the outcome. More lives saved and better cardiac function and less complications in the long term. 

 

Chest Pain / Angina

Chest pain is an important symptom of heart disease and specifically a heart attack and needs to be given immediate attention. The nature of pain can differentiate a cardiac vs non cardiac pain but not always. 

 

Chest pain location:
Upper chest,  substernal radiating to neck and jaw, substernal radiating down left arm,  susternal radiating down left arm , epigastric radiating to neck, jaw and arms, neck and jaw, left shoulder and down both arms, intrascapular. 

Heart Attack Warning Signs

 

Learn more at Heart.org/HeartAttack

 

What tests should I do?

1. Blood workup - sugars, lipids, Hb, thyroid, kidney function 

2. ECG, Echocardiogram, TMT  (Treadmill test)

3. CT coronary calcium score 

 

And if indicated based on preliminary tests 

4. CT coronary angio or conventional coronary angio 

5. Cardiac MRI or MPI or PET scan as indicated

 

TMT (treadmill test) is also called a Stress Test.

Mayo clinic says: A stress test, also called an exercise stress test, shows how your heart works during physical activity. Because exercise makes your heart pump harder and faster, an exercise stress test can reveal problems with blood flow within your heart.

 

Cardiac Risk Assessment

This is a group of tests/health factors that have been proven to indicate your chance of having a cardiovascular event like heart attack/stroke. They have been refined to indicate the degree of risk: borderline/intermediate/high risk.

 

Perhaps the most important indicators are your personal health history. These include:

•Age

•Family history

•Weight

•Smoking

•Blood pressure

•Diet

•Exercise, physical activity

•Diabetes

 

•Pre-existing heart disease, or already having had a heart attack

 

 

Tests and Imaging  

-ECG/echo/TMT (Treadmill test or stress test)

- Lipid profile 

- Sugars and HbA1C 

- Thyroid tests 

- KFT/LFT (Kidney Function Test / Liver Function Test)

- CT coronary calcium score 

- CT or conventional angiography

 

Lipid Profile

Lipid panel is the most important. According to 2002 guidelines from the NCEP Adult Treatment Panel III, the desirable ranges for the components of the lipid panel are:

•Cholesterol <200 mg/dL 

•HDL-C > 40 mg/dL 

•LDL-C <100 mg/dL

•TG <150 mg/dL

 

Non-HDL-C — calculated by subtracting the HDL-C result from the total cholesterol result; this is considered to be the portion of cholesterol that is most likely to lead to hardening of the arteries.

 

 

Very low-density lipoprotein cholesterol (VLDL-C) — calculated by dividing the triglyceride value by 5 (if in mg/dL) there is growing evidence that VLDL-C plays an important role in the process that leads to the formation of #plaques in arteries.

 

Cholesterol/HDL ratio — calculated by dividing the HDL-C result into the total cholesterol result; a higher ratio indicates a higher risk of heart disease while a lower ratio indicates a lower risk.

 

 

Statins

ACC and AHA recommend statins if you:

•Have heart disease

•LDL-C > 190 mg/dL 

•40 to 75 y with diabetes LDL-C 70-189 mg/dL but do not have heart disease

 

•40 to 75 y and do not have diabetes/heart disease but have LDL-C level between 70-189 mg/dL and 10-y risk> 7%

 

ECG 

ECG - Electrocardiogram is an important test to determine the cause of chest pain. But a NORMAL ECG DOES NOT RULE OUT A HEART ATTACK 100% of the time. Serial ECGs and additional tests like echocardiogram and Troponin blood tests may be required to make a correct diagnosis.

 

Echocardiogram can show evidence of a heart attack because the area of heart muscle supplied by the blocked artery will not move or contract as it should normal leading to RWMA or regional wall motion abnormalities. #echofirst it can also help identify other causes of chest pain.

 

Troponin blood test

Serum Troponin is a good sensitive marker of heart muscle damage and can help in diagnosing a heart attack. It is a simple blood test and results are usually available within an hour. #troponin they have a typical timeline of rise and fall in levels after a heart attack.

 

Cardiac Enzyme Test / Lipoprotein

Here are some of his answers:

1. Cardiac enzyme test is to detect heart attack 

2. Lp(a) elevated indicates high lifetime risk and homocysteine has no much role 

3. MRI can't see coronary calcium as clearly as CT can do

 

Lp(a) is a lipoprotein consisting of an LDL molecule with another protein (Apolipoprotein (a)) attached to it. Lp(a) is similar to LDL-C but does not respond to typical strategies to lower LDL-C such as diet, exercise, or most lipid-lowering drugs.

 

Since the level of Lp(a) appears to be genetically determined and not easily altered, the presence of a high level of Lp(a) may be used to identify individuals who might benefit from more aggressive treatment of other risk factors. #Lp(a)

 

CRP / C-Reactive Protein

High-sensitivity C-reactive protein (hs-CRP): High levels of hs-CRP have been found to be predictive of the future risk of heart attack, stroke, sudden cardiac death, and peripheral arterial disease, even when lipid levels are within acceptable ranges. No consensus as of now.

 

Covid and Myocarditis 

We know that #Covid causes myocarditis, not all cases of heart attack and sudden cardiac arrest are related to it. A very small number if at all.

 

(Myocarditis - inflammation of the heart muscle)

 

 

Cholesterol 

Dr Deepak Krishnamurthy wrote a fine thread on Cholesterol on Twitter:

 

https://twitter.com/DrDeepakKrishn1/status/1317097216503214080

 

Here is an attempt to summarize the thread using the tweets. (images have been omitted)

 

High LDL or bad cholesterol and a strong family history of heart attacks and bypass surgeries and angioplasties - I recommended statins. The patient said the cholesterol theory is a hoax and statins are dangerous. Argued and left my Opd and gave this feedback. #statins #LDL

 

A few months later he was rushed to emergency with a heart attack and blockages which needed angioplasty and two stents. One 100% and one 80% in major arteries. Survived and gave this feedback. #heartattack #Blockage #angioplasty #stentssavelives

 

High cholesterol is a risk factor for heart attacks and coronary artery disease. Especially LDL or bad cholesterol. There is a huge volume of data and studies which confirm this. Obesity, Diabetes, high blood pressure and smoking are other risk factors. Of course genetics too.

 

Everyone having high cholesterol doesn't need medicine (Statin). The ACC/AHA recommend calculating the ASCVD risk score and advice Statin based on risk score. #ASCVD (atherosclerotic cardio vascular disease)

 

ASCVD Risk Estimator 

https://t.co/1Ss2iGHbTC?amp=1

 

My comment:  Let's leave it to the experts, the cardiologist, to do such calculations and offer us guidance. 

 

Dr Deepak Krishnamurthy tweets:

Discuss your ASCVD risk score with your doctor. It can be calculated with an online calculator and treatment recommended based on the score.

 

Sugar the villain 

Sugar is probably a bigger villain than fat when it comes to diet. But there is no controversy on the fact that high level of bad cholesterol - LDL is a definite risk factor for heart disease!

 

Above all - Eat as less sugar as possible!

 

Will keep updating this blog and page as often as required.  Please keep checking. Do use the Search feature on the first page to locate the information that you wish. 

These are additional notes gathered by me from the Web.

 

Ischaemia

Ischaemia is the insufficient supply of blood to an organ or tissue, usually as a result of narrowing or blockage of an artery. If severe, the insufficient supply of oxygen and nutrients can result in damage to the tissue.

 

Ischaemic heart disease / Coronary artery disease / coronary heart disease

Heart problems caused by narrowed heart arteries. When arteries are narrowed, less blood and oxygen reaches the heart muscle.  This can ultimately lead to heart attack.

 

ECG - When you need it and when you don't

Excellent, informative, page about ECG:  https://choosingwiselycanada.org/ecg-electrocardiogram/

The site says:

An ECG (electrocardiogram) records the electrical activity of your heart at rest. It provides information about your heart rate and rhythm, and shows if there is enlargement of the heart due to high blood pressure (hypertension) or evidence of a previous heart attack (myocardial infarction). However, it does not show whether you have asymptomatic blockages in your heart arteries or predict your risk of a future heart attack. 

 

The test is not useful in routine checkups for people who do not have risk factors for heart disease such as high blood pressure or symptoms of heart disease, like chest pain. 

 

You may need the test for screening or occupational requirements, or if you have a personal or family history of heart disease, diabetes or other risks and you want to start exercising.

You need ECG if you have risk factors  such as high BP or symptoms such as palpitations, shortness of breath, irregular heart beats or chest pain. (personal or family history of heart disease)