Prevention is measured in ounces
Disease is measured in tons

This is a CTA or CT Angiogram. This is different than a CALCIUM SCORE, which is a general measure of calcium in the coronary arteries

Case study shows how “just-in-case” CCTA in a low-risk patient may spectacularly backfire ENDING IN A HEART TRANSPLANT!

What is CTA ? CCTA is a powerful CT Scan that can show blockage in the coronary arteries of the heart

LINK TO HEART WIRE STORY CCTA in patients that are LOW RISK wastes resources and can even lead to horrendous outcomes (case study published December 13, 2010 in the Archives of Internal Medicine).

The story is of a 52-year-old white female who had some chest pain and had a CCTA.

This was followed by an “unfortunate chain of events” ENDING WITH A HEART TRANSPLANT.

Most heart disease is PREVENTABLE!  Start YOUR PREVENTION PROGRAM EARLY.

The basics of a prevention program:

What are the basics of preventing heart disease (by the way, these also help you feel better, and age well):

1)  Do you know your VITAMIN D LEVEL? Vitamin D is a major risk factor for heart disease and cancer.

2) Have you HAD AN OIL CHANGE? You must take fish oils and reduce the BAD FATS in your diet which cause heart disease, obesity, and cancer (omega-6 highly processed vegetable oils, trans-fats, fried foods).

3) 90% of the food Americans purchase are REFINED, PROCESSED, and of poor nutrient quality – accelerating heart disease.

4) Chronic stress turns on the BAD HORMONE SYSTEMS that lead to obesity and aging (insulin, cortisol, adrenalin).

5) Just the basics of PREVENTION can heal many of the issues below: deep sleep, reasonable exercise, a Mediterranean diet, and a good supplement program (fish oils, vitamin D, multivitamins and minerals, etc.)

There are many factors that can be controlled with a great lifestyle. All of these factors are important to control and measure - EARLY. Life Extension www.lef.org

The “Less is More” series begun last April

The latest case, reviewed by Dr Matthew Becker (St Vincent’s Heart and Vascular Institute), Dr John Galla (Providence Hospital, Mobile, AL), and Dr Steven Nissen (Cleveland Clinic), describes how the well-meaning attempt to reassure a patient with a low risk of coronary disease backfired spectacularly.”Perhaps the most important point to be learned from the case  is that there are safer ways to reassure patients.  “Patients value our advice. Talking with our patients should be our first choice for reassurance.” They add that “applying the ‘less-is-more’ principles prospectively could have avoided this unfortunate case.”

From diagnostic uncertainty to disaster

The 52-year-old nurse had mild high blood pressure and mild obesity and had recently begun an exercise and diet program. She went to her physician with chest pain, but no other symptoms: she had a normal ECG with a normal cholesterol and normal CRP. Her doctor did not think this chest pain was heart related but performed a CCTA to reassure her that she was not at risk for a coronary event.

The CCTA showed some plaque. Because that calcification was difficult to quantify, the doctor recommended a cardiac catheterization to get a clearer look.

The cath revealed only a mild problem, but during the procedure, the patient complained of chest pressure, which prompted an aortogram that revealed an aortic root dissection (a complication of the heart cath) that was compromising the left main coronary artery.  Now she was in big trouble!

So she had coronary artery bypass graft (CABG) surgery and stayed in the hospital for 2 weeks with new heart failure. The bypass graft soon failed and was treated with multiple stents, but a stent  developed a thrombosis, causing an ST-segment-elevation MI complicated by cardiogenic shock. The clot was successfully treated, but the patient remained in shock and ultimately had a  heart transplantation.

Unnecessary testing happening every day

This patient had a low probability for coronary artery disease and should have been reassured and not undergone any further risk stratification.

They acknowledge the risk of complications associated with cardiac catheterization is low, but catastrophic events are always a possibility. They believe the physicians in this case overestimated the stenosis in this patient’s coronaries because they did not fully appreciate the CCTA’s potential for false-positive findings.

CCTAs specificity is only 64% to 85%, corresponding to “an unacceptably high false-positive rate” of up to 81% in some populations.

Patient could have been simply reassured

Cases like this where an inappropriate test leads to many complications and near catastrophe are rare, “but to have a CT or another test that was just done for reassurance, when you could have just told the patient ‘You’re fine,’—I think that’s done every day lots of times.

Bottom Line: Most Heart Disease is Preventable. Simple non-invasive testing, DONE EARLY, can show you if you have RISK FACTORS. Then you can build an INDIVIDUALIZED PREVENTION PROGRAM.

Don’t underestimate the BASICS OF CLEANING UP YOUR LIFESTYLE, and giving your body what it needs to heal itself. The body, if treated well, has an innate power to heal.