"The diagnosis is coronary artery disease."
That's a sentence that will, well, cause your heart to skip a beat. It came from David G. Jones, M.D., of Arkansas Cardiology and Baptist Health Heart Institute when I visited him in October.
How did I get there, besides a lifetime of burgers and fries? In August my younger brother had some tests done, ultimately resulting in quadruple bypass surgery. During his ordeal, several folks suggested I get tested as well, due mainly to some bad family history with regard to heart issues. My father, grandfather, uncle and now brother all had heart surgery and/or heart attacks. I was a prime candidate.
My family doctor told me about an Arkansas Heart Hospital program called Keep the Beat. A short phone call later, I was scheduled for a heart risk evaluation. For $100 the screening included blood tests (cholesterol, triglycerides, etc.), electrocardiogram (ECG or EKG), carotid artery screening, blood pressure test, body composition, overall risk evaluation, and the big one, the HeartSaver CT Scan.
Test results showed a good lipid panel and low total cholesterol and triglycerides. High HDL ("healthy" cholesterol), low LDL ("lethal" cholesterol). Normal electrocardiogram, nothing blocking the carotid artery. Blood pressure was high, and body mass index was embarrassing, but none of this was unexpected or particularly worrisome. Then came the results of the CT Scan.
CT stands for Computed Tomography. The process measures the level of hard calcium deposits in the arteries. The higher the level of calcium, the more likely plaque is blocking the arteries of the heart. The scan results in a numerical score: under 400 possibly indicates minimal to moderate plaque and low coronary artery stenosis.
Stenosis means there is a narrowing of the arteries in the heart due to plaque. A score of over 400 possibly indicates significant plaque. A score of over 1,000 suggests a high likelihood of significant coronary artery stenosis.
My score: 1,791. Dangerously high.
The Keep the Beat folks encouraged me to follow up with a cardiologist. I spent about 20 minutes in the parking lot calling and texting folks to let them know where I stood, with visions of bypass surgery weighing heavily on my mind.
My family doctor sends heart patients to Baptist Health, and I sought out the recommendations of friends in the medical profession. That's how I met Dr. Jones.
He was concerned that I might have severe heart disease despite minimal to no symptoms. Given my anxiety about my brother's recent diagnosis and the fact that stress tests are only 80 percent accurate, we felt that a definitive test would be best. So we decided to skip a treadmill stress test and go straight to cardiac catheterization, or heart cath.
A heart cath involves placing an IV in an artery in the groin or wrist. Through the IV a catheter is placed in the artery. Dye is injected through the catheter and X-rays are taken to check the arteries for any blockages.
If blockages are found, there are three alternatives: treatment with medication, angioplasty and/or stenting, and bypass surgery. Angioplasty/stenting can be done at the time of the heart cath by the cardiologist. Angioplasty involves passing a deflated balloon into the blocked area through the IV. When inflated the balloon expands the blood vessel and surrounding muscular wall, improving blood flow. A stent may be inserted to make sure the vessel stays open, then the balloon is deflated and pulled out.
If a blockage cannot be addressed by angioplasty/stenting, bypass surgery is the next option. Blood vessels are taken from the chest, arms, or legs by a cardiac surgeon and used to create a detour or bypass around the blockage. It used to be that bypass surgery was bad news for the patient, but now well over 90 percent recover with few or no issues.
In my case, the heart cath was done through my wrist. I don't think I was completely knocked out during the procedure but was very mellow and felt no pain. At one point Dr. Jones leaned over me and said, "That's it."
I asked what's next, and Dr. Jones replied, "Nothing, no stents, no surgery, no nothing." We were both surprised. There was some narrowing of my arteries, normal for a person my age, but mostly I was clear. A couple of hours later, I was wheeled out of the hospital with a big smile on my face. Next stop, burger and fries.
How did I dodge the bullet? Who knows? Most likely I fell into the right end of the gene pool. My diet is bad, but I've never smoked and hit the gym 5-6 days a week. For years I've taken a baby aspirin and a fistful of vitamins every day. The main difference between me and my brother is for years I've taken a statin, a drug (brand names include Lipitor, Crestor, Zocor) that helps lower cholesterol levels in the blood. My cholesterol levels were solid.
Going forward, I'm mostly staying the course with exercise and statin. It's no surprise that my doctors want me to eat better and lose weight.
From the Mayo Clinic, strategies to prevent heart disease:
Don't smoke or use tobacco
Exercise for about 30 minutes most days of the week
Eat a heart-healthy diet
Maintain a healthy weight
Get enough quality sleep
Manage stress
Get regular health screenings
The American Heart Association's warning signs of a heart attack:
Chest discomfort in the center of the chest--uncomfortable pressure, squeezing, fullness or pain--that lasts more than a few minutes, or it may go away and then return.
Discomfort in other areas of the upper body-- pain or discomfort in one or both arms, back, neck, jaw or stomach.
Shortness of breath, with or without chest discomfort.
Breaking out in a cold sweat, nausea, or lightheadedness.
I asked Dr. Jones what steps he takes to protect himself against heart disease.
He said he doesn't follow a specific diet plan but mainly eats low-fat meats, vegetables, and fruits. He avoids red meat and processed sugars. His favorite snack is his wife's homemade trail mix.
Dr. Jones exercises in a local gym 1-3 times a week. He doesn't take vitamins or supplements, but does take a statin and drinks a glass of red wine at night. His favorite health tip: "You are what you eat, drink, smoke, etc."
David Pipkin is a lifelong resident of Arkansas, currently living in Little Rock. He previously has written for the Arkansas Democrat-Gazette's sister publication Arkansas Life.
Editorial on 01/06/2019