Walk with a Doc Newsletter
Coronary Artery Disease (CAD)
Good morning! There are several myths surrounding CAD.
I love myths.
One big one is that stents prevent heart attacks in patients suffering from stable angina –
they don’t. Another is that pigeons blow up if they eat uncooked rice. Back to stents, they don’t prevent
Jack Squat . Actually, they likely prevent you paying your hospital bills on time bc they’re so expensive (stent about 4k; cost of procedure and hospital stay usually lands between 30-100k). We’ve known definitively since 2007 that medicines (listed below) are as effective as stents. Even drug eluting stents.
There is an exception, if you are coming in by squad (always call 9-1-1) with an acute coronary syndrome, or ACS, they can save your life. Other than that, they help take care of chest pain, and right now, the data shows that that’s pretty much it. They don’t prevent death, heart attack, gout or anything else any better than medicines. Those medicines are aspirin, beta blockers (second string blood pressure meds but good heart meds), ACE inhibitors, and statins.
So, if I get a stent I don’t need the medicines?
Nope, you need ’em.
So why are so many doctors putting in stents? 500k are put in each year.
What is a heart attack (also called MI or myocardial infarction)?
This is when one of the arteries that sit on top of the heart, coronaries, has a plaque rupture or a clot develop that stops blood flow (and oxygen) to the heart muscle. A lot of times people feel chest tightness, heaviness, pain, or a whole litany of other things (arm, back, neck, jaw, etc.). One quarter of the time – heart attacks are silent. A patient shows up in our office 3 and a half years after the “event” and has NO idea what/when/why/where/how/ or who. That’s not their fault.
How do you know they had one?
Usually by echo or nuclear stress test. Sometimes EKGs, but as a whole, patients give EKGs a lot more credit than they deserve. It’s a 10 second strip of electricity that, yes, has the potential to show us very helpful information. It also has the potential to show us a bunch of normal variants that can understandably get us, as patients, worked up for no reason.
What causes heart attacks?
There are known risk factors. An easy mnemonic is A, B, C, D’s
Age
Blood pressure – we will discuss at a later date over a beer (otherwise it’d be boring)
Cholesterol (this counts for 2) – LDL and HDL – (also another time, but probably over a Coke – not as boring)
Diabetes – (make that a Diet Coke)
Smoking – Tobacco Abuse (any amount is abuse to your heart, your other organs, and others). I’ve seen lots of lung/heart disease from second hand smoke.
Sedentary lifestyle
Those are the BIG risk factors. There are others that contribute as well (secondary RF’s):
Obesity
Abdominal obesity
Triglycerides
Family history of premature CAD
Psychosocial stressors
Many ask if stress causes heart attacks? Sure. I guess. You know, not in itself but it contributes to a lot of the majors and minors, and so many patients have asked me that it has to make you wonder. There is also a theory out there that MI’s are caused by inflammation, and stress does increase cortisol levels.
There is a lot of stress going around, that’s for sure. In an upcoming newsletter, we are going to address the most effective stress relievers. I’d do it now, but my friends really don’t like long newsletters. Speaking of which…
Welcome to the Family!
San Antonio, Chicago, and Springfield
“If you build it, they will come”
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Ray, people will come Ray. They’ll come to Iowa for reasons they can’t even fathom. They’ll turn up your driveway not knowing for sure why they’re doing it. They’ll arrive at your door as innocent as children, longing for the past. Of course, we don’t mind if you look around, you’ll say. It’s only $20 per person. They’ll pass over the money without even thinking about it: for it is money they have and peace they lack.
And they’ll walk out to the bleachers; sit in shirtsleeves on a perfect afternoon. They’ll find they have reserved seats somewhere along one of the baselines, where they sat when they were children and cheered their heroes. And they’ll watch the game and it’ll be as if they dipped themselves in magic waters.
The memories will be so thick they’ll have to brush them away from their faces. People will come Ray. The one constant through all the years, Ray, has been baseball. America has rolled by like an army of steamrollers. It has been erased like a blackboard, rebuilt and erased again. But baseball has marked the time. This field, this game: it’s a part of our past, Ray. It reminds of us of all that once was good and it could be again.
Oh… people will come Ray. People will most definitely come.
