How Do I Know If I Have Heart Disease?

How Do I Know If I Have Heart Disease? (Episode 54, To Your Health with Dr. Jim Morrow)

On today’s show, Dr. Morrow outlined who is at risk for heart disease and who should consider getting a Coronary Artery Calcium Scoring scan. “To Your Health” is brought to you by Morrow Family Medicine, which brings the care back to healthcare.

Morrow Family Medicine, a Member of Village Medical, is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants, and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine, A Member of Village Medical one that will remind you of the way healthcare should be.  At Morrow Family Medicine, a Member of Village Medical, we like to say we are “bringing the care back to healthcare!”  The practice has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Village Medical offers a comprehensive suite of primary care services including preventative care, treatment for illness and injury, and management of chronic conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), and kidney disease. Atlanta-area patients can learn more about the practice here.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health with Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

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The complete show archive of “To Your Health with Dr. Jim Morrow” addresses a wide range of health and wellness topics and can be found at www.toyourhealthradio.com.

Dr. Morrow’s Show Notes

Do YOU Have Heart Disease

·      Age

• Men older than 45 years of age and women older than 55 years of age (or who have gone through menopause) are at greater risk for heart disease.
• Also, the rates of heart attack over the last 20 years have been increasing for women 35 to 54 years of age.

·      Family history

• It is important for you to know what diseases and conditions run in your family and to tell your doctor.
• Talk to your parents, grandparents, siblings, aunts, and uncles.
• Ask them who in your family has had a heart attack, stroke, or other serious health problem.
• With this information, your doctor can recommend the best kinds of screening tests and preventive treatments.

·      Cholesterol

• If you don’t know your cholesterol level, ask your doctor if you should have it checked.
  • There are good (HDL cholesterol) and bad (LDL cholesterol) types.
  • To reduce and prevent high levels of bad cholesterol, eat a healthy diet and exercise regularly.
  • Some people who have high cholesterol levels may also need to take medicine to keep their levels under control.

·      Blood pressure

• If your blood pressure is high, there are things you can do to lower it.
  • Try:
    • Losing weight.
    • Not smoking.
    • Cutting down on sodium (salt).
    • Cutting down on alcohol.
    • Many people may also need to take medicine to control their blood pressure.

·      Smoking

• Quitting smoking is the single best change you can make for your health.
  • Talk to your family doctor about how to quit and stay tobacco-free.
  • If you live with a smoker, breathing his or her smoke can also affect your health. Encourage the smoker to quit.

·      Diet

• A healthy diet includes vegetables, fruits, lean meats, fish, beans, whole grains, and healthy fats.
  • Limit the amount of
    • processed foods (such as hot dogs),
    • white flour (such as crackers and white bread),
    • and sweet or sugary foods (such as soda and dessert foods) you eat.
  • You may also need to avoid foods that are high in sodium, which can increase blood pressure.
    • Sodium is found in table salt and many prepared foods, especially canned foods.
  • Although some research suggests alcohol can help protect against heart disease, moderation is the key.
    • Limit how much alcohol you drink.
    • This means no more than one alcoholic drink per day for women, and two alcoholic drinks a day for men.

·      Weight

• Being overweight puts extra strain on your heart and blood vessels.
  • A healthy diet with portion control, wise food choices, and regular exercise can help you lose weight gradually and safely.
    • It can also help you keep it off.
    • Talk to your doctor about the best ways for you to lose weight.

·      Exercise

• Exercise can help prevent heart disease and many other health problems.
• You’ll also feel better and help keep your weight under control if you exercise regularly.
• If you haven’t exercised for a while or have health problems, talk to your doctor before you start an exercise program.
• Exercising 30 to 60 minutes, 4 to 6 times a week is a good goal, but any amount is better than none.

 

Coronary Artery Calcium Scoring

·       Why Get This Test?

• The calcium that the scan is looking for is part of plaque.
• This is not the stuff you get on your teeth,
  • but a different kind found in your arteries.
  • It’s made partly of fat and calcium, and it’s not good for your heart.
• Plaque is waxy at first, and it builds up slowly.
  • But over time, it can harden.
  • You may hear doctors call this “calcified” plaque.
• It’s a problem for two reasons.
  • First, hard plaque in your arteries is like a clog in a pipe.
    • It slows your blood
    • That means some parts of your body don’t get enough of the oxygen they need.
    • If plaque collects in your heart’s arteries, you may feel chest painand discomfort, called angina.
  • Second, that plaque can break open, which can lead to a blood clot.
  • That could cause a heart attack.
• The coronary calcium scan tells you how much calcified plaque is in your heart’s arteries.
  • You and your doctor can take the results and decide if you need to make any changes to your medicine or lifestyle.

·       When Would I Get This Scan?

• The coronary calcium scan isn’t for everyone.
• Your body is exposed to radiationduring the test.
• Because of that, you want to get this scan only if it can tell you something useful.
  • First, you need to know how likely you are to get heart disease.
• Your doctor has ways to figure this out based on:

• • • Your age
    • Your blood pressure
    • Your cholesterol level
    • Whether you smoke
    • Your gender

• Heart scans make the most sense if you have a moderate, or medium, chance of heart diseasebased on these things.
• If you have only a low chance, the test isn’t likely to show any calcium.
  • If you have a high chance, you won’t learn anything more that can help you.
    • In both of these cases, you’d be exposed to extra radiation for no good reason.
  • But if you have a medium chance, you may be able to take steps to avoid heart diseasebased on the scan results.
  • Insuranceusually doesn’t cover this kind of scan. So it’s a good idea to check on that before you get the test. The cost is usually around $100 to $400.

·       What Do the Results Mean?

• The scan gives you a number called an Agatston score.
  • Your doctor may get your results the same day of the test, but it can take longer.
• Zero means the test didn’t find any calcium.
  • The higher the number, the more important it is for you and your doctor to come up with a plan.
  • Your doctor can help you understand what your score means for you. Based on the results, you may need more tests. You might also make changes in:

• • • • How much exercise you get
      • What medicines you take
      • What you eat

• Keep in mind that a high score doesn’t mean you’re sure to have a heart attack.
  • But it does signal you may need to make some heart-healthy changes to your lifestyle or consider starting a new medication.

 

Top three take-home points from the guideline 

• When to consider CAC testing?

  • In intermediate-risk or selected borderline-risk adults,
    • if the decision about statin use remains uncertain,
    • it is reasonable to use a CAC score in the decision to withhold, postpone or initiate statin therapy.
  • Emphasis on “power of zero:” use of CAC testing to identify low risk patients.
    • As opposed to risk enhancers and screening tools that may be used to identify higher risk patients,
      • CAC testing is now mostly used for identifying lower risk patients among those who would otherwise be candidates for statin therapy but who have a preference to avoid such therapy.
  • Not everyone benefits from CAC testing: selective use encouraged.
    • Many individuals can be treated with statin therapy and do not require CAC testing.
    • However, when there is uncertainly about patient risk or a desire to defer statin therapy,
      • CAC testing may be used to enhance shared decision making.
  • CAC may also be useful in older individuals.
    • The new guideline also supports the utility of CAC measurement in identifying the absence of atherosclerotic plaque in older adults.
      • Specifically, the guideline states that in adults 76 to 80 years of age with an LDL-C level of 70 to 189 mg/dL, it may be reasonable to measure CAC to reclassify those with a CAC score of zero to avoid statin therapy.

·      Results

• The score reflects the total area of calcium deposits and the density of the calcium.

• • • A score of zero means no calcium is seen in the heart.
      • It suggests a low chance of developing a heart attack in the future.
  • When calcium is present, the higher the score, the higher your risk of heart disease.
    • A score of 100 to 300 means moderate plaque deposits.
      • It’s associated with a relatively high risk of heart attack or other heart disease over the next three to five years.
  • A score greater than 300 is a sign of very high to severe disease and heart attack risk.

 

References: mayoclinic.org and familydoctor.org