Hi again, it's Dr. Jamnadas From cardiovascular interventions.
And today I have a very important topic and this topic is your
incomplete cardiac examination.
So the question is why would you get an incomplete cardiac examination?
Well, unfortunately, most people are getting an incomplete
cardiac evaluation because things have evolved so much
but we still do things the old fashioned way.
Most people go to the doctor's office saying
Hey, I need to be checked out from cardiology to make sure I'm not going to get aheart attack,
or I don't already have heart disease or congestive heart failure or valve
problems. But in fact, the workup that they're getting is completely incomplete.
So let me explain to you what I mean by that. So before I get into that.
There's a few things you need to understand. Number one,
most heart attacks are silent.
What does that mean?
That means the patient doesn't even know they're having a heart attack or they
have atypical symptoms. They may just have a little bit of indigestion,
a little bit of heartburn, some dizziness,
maybe some sweating and a shortness of breath.
And actually that was a heart attack. So they get missed.
So the first thing is that symptoms where the elephant comes and sits on your
chest and you're getting chest pain.
That's the minority don't think that oh yeah,
I'm going to get a warning and this is going to happen.
No most heart attacks occur with no warning. They just happen.
So that should really be a very scary point. That's number one.
So myocardial infarctions, don't come with a warning ahead of time. Number two,
ischemia ischemia means lack of circulation.
Let's say you have a blockage in one of your arteries.
Most ischemia is silent. What does that mean?
That means you don't even know that you have a blockage.
That means you can walk up the stairs and you can run and you can jog and you
can go to work and you have blockages. And every time you're doing that,
you're not getting enough circulation.
And yet you don't even know that you got a blockage because it's an iceberg,
chest pain is only the tip of the iceberg.
So what happens is when there's a blockage and let's you're walking up a flight
of stairs,
the first thing is that the lack of circulation is going to cause what we call
diastolic dysfunction of the left ventricle.
And you're not even going to know about that. Yes,
your heart muscle is not relaxing properly.
Maybe you'll get a little bit of shortness of breath when you're walking.
So shortness of breath on walking means that yes, you have a blockage.
And then you might find that you get a little, uh,
lightheaded or you start getting chest pains later on. So chest pain is,
is a very late event. So majority of the patients, when they come to us,
it's not that, oh yeah, I've had a heart attack, but I had lots of warnings.
You know, for the last few years I've been getting more and more chest pain.
Now they come, they get a heart attack. They're at the hospital, they call 9 1 1
They end up there or they come in here,
our cat them because they're getting some symptoms and they have a tight
blockage. This is a bit doc. How can I get a 90% blockage overnight? Well,
because you don't get the warning signs.
if most ischemia is silent and if myocardial infarctions
don't announce themselves and more than 50% of the heart attacks have no
previous warning,
then what kind of a physical examination or cardiac examination,
can you undergo ahead of time to know that you are one of those that's going to
get a silent heart attack or that you already have blockage and don't know about
it. So what do you do?
You go to the cardiologist and we do a stress test on you.
So let me explain what a stress test is.
A stress test is to see if there's any lack of circulation.
But if you look at my previous videos, you'll see,
see that if you have an artery, there's an artery.
You have to have a blockage inside that artery of at least 70%,
before this lack of circulation.
So therefore you can have a blockage in that artery like this,
and you're getting lack of circulation. This is all the plaque build up in here.
And you can have lack of circulation going through there.
Only there's a 70% or more blockage, so you can have 50%,
60%, and there's still plenty of blood going through.
So a stress test only picks up blockages that are
greater than 70%. Well,
the next question is don't you want to know if you have a blockage that's less
than 70%. Of course you want to know that?
Why do you want to wait till you only find out if you have a 70% blockage or
more? So the stress test has its value,
but only in picking up blockages that are more than 70%.
It doesn't tell you whether you have a 30, 40, 50, or 60% blockage.
Next question then obviously is, okay. So if I have a 40, 50% blockage,
so what if it's not causing lack of circulation? And the answer is this. When
you have an artery with only a minor blockage,
let's say a 30 or 40% blockage like this one, I'm showing you here,
what's wrong with that? It's not restricting blood flow.
This got plenty blood flow going through that. So what's wrong with that? Well,
the problem with that is that it can rupture.
That means there's a crack in the plaque and then a blood clot forms in it.
And if the blood clots are a big one,
you have no circulation going through and that's called a heart attack.
So blockage is more than 70 can cause chest pain.
But I told you just don't rely on chest pain. The stress test will pick that up,
but minor blockages, they crack and they cause a blood clot in it.
And if this blood clot is a big one, you're going to get a heart attack.
If it's a moderate one, you're going to get new onset of unstable angina.
As we call it. New onset of chest pain and EKG changes.
So plaques that are minor crack and most heart attacks don't
occur because of progressive blockage from 70 to 80 to 90,
then 100 most heart attacks,
which are caused by complete blockage occur at a site of
minor blockage that cracks open and a blood clot forms in it.
So you went from a minimum blockage,
one day able to do anything and everything to now having a heart
attack or having severe chest pain or minimal exertion.
You need to understand what is going on in the
arteries. And the pathology,
heart attacks are not caused by progressive blockage in the artery.
Heart attacks are caused by rupture of the plaque.
The rupture of the plaque causes a blood clot to form in it.
If the blood clots are big one, you're getting a heart attack.
So you really want to detect lack of circulation and that you do with the
stress test, which we are doing.
But how do you find these minimum blockages?
How do you find those that are the ones that are actually your risk of having a
heart attack?
Cause your risk of having a heart attack is related to how much plaque there is.
The more plaque in your coronary arteries that are not blocking your artery is
not blocking the flow of the arteries. There's still plenty blood,
good blood flow going through, but the more plaque,
the greater the chance it's going to crack one day and when it cracks,
it's going to cause a heart attack. So in order to detect this,
this is where your incomplete examination comes in.
This is the reason why we do coronary calcium scores.
So when you do a CT scan of your heart,
looking at coronary calcification,
we can find these plaques because these plaques are full of
calcium. The plaques,
the blockages are full of calcium and that's what you pick up on the CT scan.
So it's called a coronary calcium score and know your score.
If you want a complete examination,
you have to know your coronary calcium score.
If you have zero calcium in your arteries, you don't have blockage.
If you don't have blockage, you're obviously going to pass your stress test,
but also there's no plaque. If there's no plaque,
you can crack the plaque and you're not going to get a clot forming in it.
And basically your prognosis is very good.
Your chances of having a heart attack, it's like less than one in 100,000.
And for the next 10 years, your survival is 99.99%.
Now the more calcium you got in your coronary arteries on the scan,
the higher your risk of having a plaque rupture.
So why would you want to know that?
Because you'd want to know this because you would then do prevention.
So the part of the examination is to detect that you have coronary calcium and
then look to see what you can do to prevent more buildup of plaque,
more buildup of calcium, and also stabilize the plaque that you already have.
To stabilize the plaques that you already have. You need a metabolic workup.
So part of your income complete cardiac examination is not
looking at coronary calcium and,
not looking at your metabolic condition because it is your
metabolic condition, your metabolism, your physiology.
That's going to dictate whether your plaque is going to crack or not.
So I hope I've made myself very clear here that the mechanics,
the mechanical obstruction will lead to angina,
but the plaques they are dictated by your physiology,
your biochemistry, your metabolism.
So there's two steps to the incomplete examination that we need to fill up.
Number one, you need to know your coronary calcium score. If you have calcium,
you need to know your metabolic condition.
What do I mean by metabolic condition?
So this is where we do a very thorough evaluation. What is your weight?
What is your body mass index?
What is your fat composition of your body are the inflammatory markers in your
body? Because if there's inflammation, you're going to rupture your plaque.
What is your insulin level?
Because most of these plaques that rupture tend to occur in diabetic patients
or prediabetics were very high insulin levels.
So we actually measure your insulin levels to show you that, yes,
you may not be a diabetic, but you're a pre-diabetic.
And the sad thing is almost 80% of the population have metabolic
syndrome.
And this is as a result of the lifestyle that we have together with the foods
that we are eating these days,
we have metabolic syndrome so metabolic syndrome is rampant.
So we look at your insulin, sugar metabolism, of course,
cholesterol, inflammatory markers, sleep apnea,
your bio tone, which is the bacteria in your gut.
And we look at other conditions that you may have such as connective tissue
disease
and toxicities that can also lead to plaque formation and plaque
rupture. So the traditional risk factors that we used to look at,
which is high blood pressure and cholesterol and history of smoking is
very incomplete.
Your cardiac examination is not complete until you have had a thorough
evaluation,
which includes coronary calcium and your complete metabolic makeup. Now,
if you detect that your metabolic makeup is abnormal. What can you do about it?
There's a lot that can be done.
Now I know that the onus then is on you to make those changes.
You need to make dietary changes, but there's also supplements,
fantastic supplements,
but mostly dietary lifestyle changes that have to be made.
And we do this in our office to make sure that your metabolic
condition changes and goes back to normal. Otherwise,
if you have coronary calcium and you're feeling great and you pass your stress
test, you see still going to have a heart attack coming down the road. So I,
that this was helpful and I hope you've learned two things.
The incomplete examination does not have coronary calcium and does not have your
metabolic workup. So look forward to some more videos on this.
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take care.