Cardiac Testing- Best Test options

[Capin]

CT calcium scan I get one done about every three years now most times when someone has a "heart attack" their heart is fine but arteries are clogged!
And of course ejection fraction
And take lots of Phish oil

 

[maldorf]

I cant get EKG cos i am in UK and even though i have private healthcare i still have to see a NHS gp ( govt free doctor) . they usually good and give whatever i ask like , my elbow hurting i want to see a ortho my stomach is boated i want to see a gastroenterologist, i need to see a chiro they refer me cos they do not care as the NHS is not paying for it so just write a generic letter and i call my insurance and they arrange it all paid for but for EKG i dont know what shit i can make up lol i mean i am going to have to get a private referral to see a cardiologist and he will only write a EKG scan so the gp will access me and will say i am ok. I am its not the same thing asking to see a upper limb specialist cos my elbow is hurting cos the gp cant argue with that but with this he still have to check me etc and my guess is he would be like no you fine.. nothing serious to see cardiologist so cant get EKG done mate

Sounds like a mess. Here in the states people can just go in and get an EKG done even at the primary care doctor. How I had my very first one done. Too much red tape over there.

 

[maldorf]

lots of unnecessary tests discussed here. Tell a doc you have chest pain, that will get you an EKG. If anything is abnormal, bundle branch blocks, re polarization, ventricular hypertrophy etc your cardiologist will perform an eco.

What I said earlier. Get an EKG and then they will ask for an echo is something is wrong. Good idea to tell the doctor youre having chest pains. That should allow him to ask for an EKG. Too bad you have to lie but you do what you have to do.

 

[maldorf]

I had a EKG before my surgery two months ago.. They laid me down and started.. Then the lady got a very concerned look on her face and said " are you feeling ok?" I said yeah.. Just then the other nurse looked at the screen and said " you are having a heart attack sir ".. I was like WTF.. I said I felt fine.. The lady made a call and made me lie there and two other people came in .. I was thinking this is insane.. I finally got a bit passed and sat up and said " I'm not having a FRICKIN heart attack " .. When I sat up the nurse said " oh there's the issue ".. Apparently the electrode on my left side on my rib cage was disconnected showing a heart attack.. Was not pleased..

Dang, I hate it when nurses overstep their boundaries. She should have known better. Usually the sign of a heart attack is an elevated ST segment. So I guess it must have done that. I haven't done an EKG since 1994 in grad school so I forget what would happen if one of the chest leads would come off.

Heck, I had the paramedics that took me in the ambulance to the hospital this past March tell me I was having a heart attack. At the time I was having bad arrhythmias that was throwing my heart into V fib and my defib had gone off 3x in two days. I really believed them and thought I was going to die because I figure my heart couldn't make it through another heart attack. I'm not Dick Cheney! Turns out I wasn't having one, not sure why they said that. The docs at the hospital said the EKG didn't show one. Scared the living shit out of me.

To top it off, I wanted to go to the hospital where all of my cardiologists are but it is about 30 minutes away. They said it was an emergency and wouldn't take me there, they forced me to go to a lesser hospital because it was closer. Sucks not being in control. I did not protest too much though since I thought I was having a heart attack.

 

[asteelz]

What I said earlier. Get an EKG and then they will ask for an echo is something is wrong. Good idea to tell the doctor youre having chest pains. That should allow him to ask for an EKG. Too bad you have to lie but you do what you have to do.

i agree, its quick easy and identifies/ rules out a host of issues. Its a shame he may have to lie but its not for a nonsense reason.

Is there a test that visually shows the insides of your arterial walls to see the percentage of plague build up? If so can you get angioplasty to break up the narrow passages caused by plaque build up?

an xray can identify cardiomegaly, and a few other signs of CHF. a CT scan can show plaque but it can not identify what kind of plaque, which seems not to matter so much anymore as the consensus is shifting. where as before hard plaque was the cause for heart attacks, now soft and vulnerable plaque are known to case MI as well. I suppose an MRI can detect blockage, tissue damage etc but I dont see these performed often.

Yes i would think so, with your long standing history of high level bodybuilding and ped use a good cardiologist would likely act on any abnormal findings. usually an angioplasty is followed immediately by a stent, which is pretty common to see these days.

I had a EKG before my surgery two months ago.. They laid me down and started.. Then the lady got a very concerned look on her face and said " are you feeling ok?" I said yeah.. Just then the other nurse looked at the screen and said " you are having a heart attack sir ".. I was like WTF.. I said I felt fine.. The lady made a call and made me lie there and two other people came in .. I was thinking this is insane.. I finally got a bit passed and sat up and said " I'm not having a FRICKIN heart attack " .. When I sat up the nurse said " oh there's the issue ".. Apparently the electrode on my left side on my rib cage was disconnected showing a heart attack.. Was not pleased..

LOL this is why i HATE when nurses try to diagnose anything. its completely against their scope of practice. Not saying there arent some very knowledeable nurses out there, but there is a reason they spent 2 years in shool and a PA/NP/DO/MD spends 7-12.

I had a nurse inform my parents that my mothers brain tumor was benign, despite her history of multiple cancers. Needless to say i flipped out when i got to the hospital and found out, as the tumor was absolutely not benign.

 

[machinemind]

thanks for chiming in machine. from your posts you sounds like a medical expert as well like GG. what is your background/ specialty if you dont mind me asking? cheers

You are quite welcome. Have been practicing medicine for about 8 years, with specialization in Intensive Care (inpatient only). Intensivists don't have to worry much about inclusion criteria for exams and testing because the patient is often, literally, dying. This is why I wouldn't have any experience with PLAC because it is a foregone conclusion that the person is not well- a clinic doc may be more inclined to order it. So I'm kind of weighing the practical with experience. That's why if you include the caveat of unlimited funds, it changes the picture dramatically. Many inflammatory markers are very, very generalized. No disrespect intended to anyone who values the PLAC, but if it was that good clinicians would be ordering it left and right. Perhaps it is more common outside the U.S. Take it for what it's worth but neither myself, nor colleagues, have ever ordered that particular marker. I may need to be illuminated on it a little more. Genetic testing is the wave of the future I would expect to see much better tests ($$$$) in the next 5-10 years.

 

[nothuman]

Dang, I hate it when nurses overstep their boundaries. She should have known better. Usually the sign of a heart attack is an elevated ST segment. So I guess it must have done that. I haven't done an EKG since 1994 in grad school so I forget what would happen if one of the chest leads would come off.

Heck, I had the paramedics that took me in the ambulance to the hospital this past March tell me I was having a heart attack. At the time I was having bad arrhythmias that was throwing my heart into V fib and my defib had gone off 3x in two days. I really believed them and thought I was going to die because I figure my heart couldn't make it through another heart attack. I'm not Dick Cheney! Turns out I wasn't having one, not sure why they said that. The docs at the hospital said the EKG didn't show one. Scared the living shit out of me.

To top it off, I wanted to go to the hospital where all of my cardiologists are but it is about 30 minutes away. They said it was an emergency and wouldn't take me there, they forced me to go to a lesser hospital because it was closer. Sucks not being in control. I did not protest too much though since I thought I was having a heart attack.

Maldorf you are like Ric Flair man. Nothing can ever kill you

 

[nothuman]

http://www.knowyourrisk.com/wp-content/uploads/2016/05/Lp-PLA2_Activity_Handout.pdf

 

[Stewie]

Abstract 16318: Niacin Dramatically Raises the Endothelial Inflammatory Marker Lp-PLA2: The Reason the AIM-HIGH Trail Failed Despite Improvements in HDL and Triglycerides | Circulation

Abstract

The recent cancellation of the AIM-HIGH Niaspan/Simvastatin trial, despite increased HDL levels and decreased Triglyceride levels, throws into question the entire paradigm of HDL elevation in preventing heart disease. On the other hand, an alternative explanation of the null results of the trial is that Niacin caused a problem that negated the otherwise beneficial effect of HDL elevation. We believe we have discovered that reason, as a result of serial examinations of the endothelial inflammatory marker LpPLA2 (Lipoprotein-associated Phospholipase A2 in a patient population with CAD started on extended release niacin.

986 pts, aged 38-92, M:F ratio 1:1 with either documented CAD, or risk factors for CAD, Lp(a), hypercholesterolemia with low HDL, were started on dietary intervention (a limited grain, Mediterranean type diet) coupled with 500-1,500mg slow release Niacin. As part of a comprehensive lipid panel, (BerkeleyHeartLabs, Alameda, CA) LpPLA2 levels were measured at baseline and every 3 months; pts have been followed for 1-8 years, mean 6+/−2 yrs. As reported elsewhere, if LpPLA2 levels rose above 200 ng/ml, pts were started on Fish Oil, Spirolina, Grape Seed Extract and Pycnogenol.

LpPLA2 levels increased in all pts begun on a Niacin regimen. Baseline levels of 167+/−50 ng/ml increased to 212+/−43ng/ml (p<0.001). Mean individual increase was 62+/−30ng/ml. Sixty-five % of pts started on Niacin, had LpPLA2 levels increase above the normal upper level of 200ng/ml. There was no corresponding increase in hs-CRP or fibrinogen levels. The addition of Fish Oil, Spirolina, Grape Seed Extract and Pycnogenol reduced LpPLA2 levels but did not return them to baseline.

We conclude that extended release Niacin dramatically increases the endothelial inflammatory molecule Lp-PLA2, which attracts oxidized LDL into endothelial cells. This finding probably explains why despite elevated HDL's in the AIM-HIGH trial, no favorable results were obtained. We strongly recommend that pts on Niacin should have Lp-PLA2 levels checked and if elevated, started on Fish Oil, Spirolina, Grape Seed Extract, and Pycnogenol.

As for thee pesky lipoprotein(a), this little hybrid molecule acts as an acute phase reactant. Meaning, it's not a good idea to test after bouts of tissue breakdown, such as a few days after training.

What to-do, what to-do with these itsy-bitsy ruination PAF acetylhydrolases.

No matter how good the sharpshooter you are, sometimes the targets move.

 

[nothuman]

Abstract 16318: Niacin Dramatically Raises the Endothelial Inflammatory Marker Lp-PLA2: The Reason the AIM-HIGH Trail Failed Despite Improvements in HDL and Triglycerides | Circulation

Abstract

The recent cancellation of the AIM-HIGH Niaspan/Simvastatin trial, despite increased HDL levels and decreased Triglyceride levels, throws into question the entire paradigm of HDL elevation in preventing heart disease. On the other hand, an alternative explanation of the null results of the trial is that Niacin caused a problem that negated the otherwise beneficial effect of HDL elevation. We believe we have discovered that reason, as a result of serial examinations of the endothelial inflammatory marker LpPLA2 (Lipoprotein-associated Phospholipase A2 in a patient population with CAD started on extended release niacin.

986 pts, aged 38-92, M:F ratio 1:1 with either documented CAD, or risk factors for CAD, Lp(a), hypercholesterolemia with low HDL, were started on dietary intervention (a limited grain, Mediterranean type diet) coupled with 500-1,500mg slow release Niacin. As part of a comprehensive lipid panel, (BerkeleyHeartLabs, Alameda, CA) LpPLA2 levels were measured at baseline and every 3 months; pts have been followed for 1-8 years, mean 6+/−2 yrs. As reported elsewhere, if LpPLA2 levels rose above 200 ng/ml, pts were started on Fish Oil, Spirolina, Grape Seed Extract and Pycnogenol.

LpPLA2 levels increased in all pts begun on a Niacin regimen. Baseline levels of 167+/−50 ng/ml increased to 212+/−43ng/ml (p<0.001). Mean individual increase was 62+/−30ng/ml. Sixty-five % of pts started on Niacin, had LpPLA2 levels increase above the normal upper level of 200ng/ml. There was no corresponding increase in hs-CRP or fibrinogen levels. The addition of Fish Oil, Spirolina, Grape Seed Extract and Pycnogenol reduced LpPLA2 levels but did not return them to baseline.

We conclude that extended release Niacin dramatically increases the endothelial inflammatory molecule Lp-PLA2, which attracts oxidized LDL into endothelial cells. This finding probably explains why despite elevated HDL's in the AIM-HIGH trial, no favorable results were obtained. We strongly recommend that pts on Niacin should have Lp-PLA2 levels checked and if elevated, started on Fish Oil, Spirolina, Grape Seed Extract, and Pycnogenol.

As for thee pesky lipoprotein(a), this little hybrid molecule acts as an acute phase reactant. Meaning, it's not a good idea to test after bouts of tissue breakdown, such as a few days after training.

What to-do, what to-do with these itsy-bitsy ruination PAF acetylhydrolases.

No matter how good the sharpshooter you are, sometimes the targets move.

More evidence a standard lipid panel is weak in comparison to a lot of the other tests out there, especially Lp-PLA2. If niacin raises HDL but also raises Lp-PLA2 and homocysteine, it can't be worth taking in most instances.

What I didn't know is that Lp(a) and Lp-PLA2 are falsely elevated after training. I'll have to keep this in mind next time I'm due for bloodwork.