All causes of sudden unexpected death: The
first indication of heart disease is actual sudden death in
150,000 Americans each year! Of all unexpected deaths, many
causes are "heart
attacks" and other heart-related deaths. All
sudden death causes
American College of Cardiology: their
site has a large number of on-line documents about risk and
treatments, etc.; in that website they are called "Clinical
Global risk assessment: you
can self test with this on-line calculator tool, the "Framingham CHD risk stratification risk score" (FRS) assessment.
Risk factors (and lab tests) for cardiac
disease: conventional wisdom has it that there are 4 major,
modifiable, traditional risk factors for MI: smoking, diabetes
mellitus, high blood pressure (hypertension), and elevated
blood cholesterol (hypercholesterolemia)4.
Among patients with coronary heart disease (CHD), 80-90% will
have one or more those 4 risk factors5.
Genetic predisposition (Do "heart
attacks" run in your blood relatives...in family genes?
Has anyone dropped dead of a "heart attack" below
age 50?): a heavy percentage of risk is here
tests related to heart attack risk
- Excesses or Deficiencies (too
little exercise...poor heart fitness) of the below items
- Regular exercise: are you exercising
enough? [cardiopulmonary fitness
- Proper diet:
- folic acid: helps prevent elevation
of total homocysteine (tHcy) (if elevated, take
1 mg folic acid per day)
- vitamin E 400-800 mg./day: the Cambridge
Heart Antioxidant Study (CHAOS) showed a 77%1 reduction
in AMIs with this intake (other antioxidants
are selenium, vitamin C, and beta-carotene)
- Proper lifestyle habits: quit smoking!
- Maintain proper weight: calculate
with Medical College of Wisconsin's on-line
calculator and get your BMI and see if you are "overweight" (BMI
25-29) or even "obese" (BMI 30 or higher). Goal is less
- Control heart-injuring disease:
- have a lipid profile done under optimal
conditions (no illness, change of activity level or
change of diet in past 3 weeks; nothing to eat after
10 pm...a 9-12 hour fast...the night before the specimen
is drawn) and address any abnormalities. Goal is total
cholesterol no higher than 200. Then calculate
risk with the Medical College of Wisconsin's on-line
calculator and/or the Pfizer on-line
calculator and/or the NIH on-line
calculator. Check the NIH's May 2001 3rd report
III) of the NCEP Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults.
Consider medications to lower bad cholesterol (statins)
or increase good cholesterol (niacins). Since inflammation
is thought to be a key factor in the coronary artery
lesions, an aspirin a day (especially if hs-CRP indicates
an increased risk) is thought to be advantageous.
- check fasting blood glucose and, if elevated,
address the possibility that you are diabetic; and,
if diabetic, be diligent about managing and controlling
- starting at one of the pharmacies or
chain stores, check your blood pressure on their machine
and, if elevated, address the possibility that you
are hypertensive. And, if so, be diligent about
management and treatment. Goal is systolic
no higher than 120 and diastolic no higher than 80.
Diagnosis of silent disease and/or acute MI:
History & physical for both typical: (crushing
chest pain or tightness on, or shortly after, exertion; & diaphoresis
[sweating]) or atypical presentations...myocardial
Electrocardiogram (EKG or ECG): first-line
ER test or non-emergency screening test searching for electrical
abnormalities possibly reflecting cardiovascular abnormalities
(only about 50% sensitive for cardiovascular abnormalities).
"Acute MI profile" emergency department lab
tests for LMC-ER: [2001
letter] it is crucial to fix the time
of onset of the episode in order to properly interpret
the lab test profile [2002
update letter]; informative lab
treadmill: EKG test while you walk
on a treadmill at certain speeds and inclines; looks for
stress-related electrical reflections of cardiovascular
abnormalities; can also have false positive and false negative
treadmill stress followed by echocardiogram: the "echo" component
of this test searches for heart muscle dilation and contraction
abnormalities in the walls of the 4 chambers of the heart
which might reflect cardiovascular abnormalities.
radionuclide stress test: a "nuclear
medicine" stress test; takes about a half day; radioactive
isotope is injected in your vein; the treadmill stress
exposes old hear scar, unstable heart scars, and areas
in heart muscle which get too little blood when under stress.
Areas are revealed as metabolic "cold spots".
Coronary arteriography: a catheter is
inserted in the groin artery and guided into the heart where
die is squirted into the two coronary artery entries; about
33% of cases result in insertion of an average of just over
one stent per patient; there is a low false negative diagnostic
rate (failure to see an occluding plaque. However, 6% of men
and 10% of women with EKG ST-segment elevation have normal
or near-normal angiograms/arteriograms8.
Of cases of unstable angina and normal or near-normal arteriograms,
there is a 2% risk of death in the next 30 days8!
And, some 20% of troponin negative, unstable angina non-ST-segment-elevated
acute coronary syndrome (ACS) patients visiting an ER with
chest pain have a cardiac event within the following six months.
Coronary intraluminal ultrasound: similar
to arteriography but use an ultrasound probe rather than dye.
(fast spin) spiral CT &/or (electron
beam tomography) EBT: detects coronary calcification
and "scores" it...some extend the test to "whole
body". Arterial calcification means damaged arteries:
such as S. C. Heart's "HeartSense" (Columbia,
Lexington Medical Center's "HeartReach" (Lexington,
S. C.) EBT for coronary artery calcium ("CAC")
scoring; see "Chest
X-ray" web site for techniques, anatomy, and
risk calculations for calcium and other factors
Mammography: vascular calcification of
breast arteries seen on mammograms is associated with an increased
incidence of CAD, & subareolar "whiteout" density
is a reflector of chronic CHF.
CAP Today, "Picking New Winners for Cardiac
Risk", interviewing H. K. Naito, Santica M. Marcovina,
Jerome Cohen, Richard Cannon, Paul Ridker, Nader Rifai, November
JAMA editorial, "Inflammatory Markers in
Coronary Artery Disease...", Vorchheimer DA and Fuster
V, 286(17):2154, 7 Nov. 2001.
JAMA editorial, about EBT & CAC detection,
Greenland P, 289(17):2270, 7 May 2003.
Major Risk Factors for Cardiovascular Disease:
Debunking the "Only 50%" Myth, Canto JG & Iskandrian
AE, JAMA 290(7):947-949, 20 August 2003.
Prevalence of Conventional risk Factors in Patients
With CHD, Khot UN, et. al., JAMA 290(7):898-904, 20 August
Major Risk Factors as Antecedents of Fatal & Nonfatal
Coronary Heart Disease Events, Greenland P, et. al., JAMA 290(7):891-897,
20 August 2003.
Emerging Risk Factors for Atherosclerotic Vascular
Disease: A Critical Review of the Evidence, Hackam DG & Anand
SS, JAMA 290(7):932-940, 20 August 2003.
Angina With "Normal" Coronary Arteries,
Bugiardini R. & Merz CNB, JAMA 293(4):477-484, 26 January
CAP Today, "Clearing a path for New Cardiac
Markers", interviewing R. Christenson, Alan Maisel, Stanley
Hazen, Ken Buechler, John Shaw, Jessie Shih, Robert Olsen,
- CAP Today, "Using markers for a head start on heart risk", Robert Christenson, PhD, Dec. 2007.
(posted Oct. 2001; latest small addition without page updating 6 April 2014)