<p>Glad you got outside, Michael. I think my son and the girlfriend went outside today, but I haven’t heard yet.</p>
<p>10 miles- 55-58 degrees, partly sunny, some wind. It felt difficult. I’m struggling to find that pace that is comfortable and where my HR stays where it should. Nuu-Muu dress with short sleeved tech shirt over it and arm warmers. Shed the arm warmers at about 7 miles.</p>
<p>Question for iDad and other smart folks. I should know this after all my years around Ken Cooper and his clinic, but since I was invincible, I didn’t pay that much attention to the “old people” issues. I DID have some max stress tests there as part of some studies, though, and a fast CT scan (heart) as part of a study.</p>
<p>The question is- if you wanted to make sure your heart was OK and you didn’t have a blockage or anything- what test would you get? I know my GP does an EKG when I go for my annual checkup, but I’m just sitting there with the electrodes on me. I don’t think that’s enough. One of the top runners here just had an issue and had a blocked artery and got a stent. He’s 73. No warning until he was diagnosed with Graves Disease and he had some bad races in the last year. Not sure if the Graves caused the heart issue or if it is separate.</p>
<p>I worry since I know Dr. Cooper always said that frequently the first sign of heart disease is sudden death.</p>
<p>MOWC, my friend the cardiologist who’s my doc and understands athletes of our “vintage”, has me do a 3D Echo cardiogram stress test each year that’s basically a stress test coupled with an ultrasound 3D cardiogram the instant I get off the treadmill. I’ve also done a Cardiolite Stress Test where the Cardiolite dye is traced immediately after the stress test so that the blood flow is more visible. He feels that either of these will reveal blockages because of the imaging of the heart functioning under high stress load. I’ve also done an ultra fast cardiac cat scan but he’s not a big fan of them for people who are asymptomatic because of the risks of false positives caused by various artifacts. At least that was the case when I did it in 1999 and in fact showed what could have been interpreted as a slight blockage but which my cardiologist thought was more likely an artifact caused by positioning of one of the blood vessels. Interestingly, he thinks a normal stress test is useless for athletes with high cardio fitness levels who are asymptomatic. He basically says that my typical cardio workouts are like doing a stress test to points above the normal stress test protocols and if I feel asymptomatic working out, then a normal stress test isn’t going to show anything either.</p>
<p>I understand your concern. My maternal grandfather died at the age of 65 from a massive heart attack and all my adult life I think that has been in the back of my mind even though I have no medical conditions that one would associate with being at risk.</p>
<p>Thanks, Michael. That’s great info. Is it covered by insurance? Do I just get my GP to refer me?</p>
<p>Yes, all of the tests have been covered. Sometimes you need to be able to “articulate” a reason a test beyond the normal stress test is medically appropriate but that should be something your doc can assist you with. I have Keystone Direct Point of Service which enables me to go to any network cardiologist without a referral from my GP and my cardiologist then orders the test. He does the stress tests in his office. When I did the cat scan, he gave me a prescription for it and I had it done at the hospital he has privileges at. </p>
<p>Super. Thanks!</p>
<p>MOWC:</p>
<p>I’ll get back to you. There are some non-invasive tests that are quite good at identifying artery plaque. I haven’t paid enough attention to them to know them from memory, so I’ve got to look up a couple. One is an elaborate CT scan, but there is also a simple calcium blood test of some sort. Of course, doing the LipoProtein NMR cholesterol test to get a particle count of LDL and HDL cholesterol would tell you a lot about your risk of coronary artery disease – useful for people that have “good” basic cholesterol test numbers, but are at high risk due to large particle numbers.</p>
<p>Philosophically, we have to think through the ramifications of pushing hard for testing. If you go far enough down that road, they’ll probably find “something” and want to treat it. I figure my risk of coronary heart disease is very low at this point based on all of the standard markers. I eat healthy. I exercise. So, there’s nothing more I can really do from a lifestyle standpoint. My doc did the standard EKG test during a physical a couple years ago. All normal. Honestly, I figure if I keel over dead from a coronary next week, it was probably my time.</p>
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<p>To the basement for me. Warmup, core, and power followed by strength sets of:</p>
<p>Single Leg Deadlift (60 lb)
3-pt row (60 lbs)
DB front squat (2 x 30 lb)
TRX pushups (hands in straps).</p>
<p>The single leg deadlifts with that much weight are really tough. Two sets were OK. One set was laughably bad.</p>
<p>MOWC:</p>
<p>Here ya go. It’s a coronary calcium scan. Costs a couple hundred dollars. Images calcium in the arteries as a proxy for plaque.</p>
<p>Here’s the mayoclinic blurb:</p>
<p><a href=“Heart scan (coronary calcium scan) - Mayo Clinic”>Heart scan (coronary calcium scan) - Mayo Clinic;
<p>Here’s the Wheat Belly cardiologist talking about the test:</p>
<p><a href=“Wheat Belly Author Dr. William Davis Answering Questions About Getting A CT Heart Scan - YouTube”>Wheat Belly Author Dr. William Davis Answering Questions About Getting A CT Heart Scan - YouTube;
<p>And, a YouTube of somebody getting the test:</p>
<p><a href=“Christine Moore Getting A Heart Scan - YouTube”>Christine Moore Getting A Heart Scan - YouTube;
<p>This would give pretty conclusive evidence on coronary artery plaque, but of, of course, it won’t tell you anything about other issue like defective heart valves and so forth.</p>
<p>Here’s the info on the NMR Lipoprofile cholesterol test. </p>
<p><a href=“http://www.liposcience.com/nmr-lipoprofile-test”>http://www.liposcience.com/nmr-lipoprofile-test</a></p>
<p>It can be ordered instead of the usual cholesterol screening test for your physical. It gives the doc everything that is on the standard test, plus some additional information such as particle counts. When billed at insurance company prices, the cost is trivial. If I recall, maybe $20 or $30 even if your insurance doesn’t cover it.</p>
<p>“MOWC, my friend the cardiologist who’s my doc and understands athletes of our “vintage”, has me do a 3D Echo cardiogram stress test each year that’s basically a stress test coupled with an ultrasound 3D cardiogram the instant I get off the treadmill.”</p>
<p>This is what I had to do when my GP suspected heart problems (that swell time a couple of years ago when I temporarily disappeared from CC). It was covered by my insurance.</p>
<p>IDad. Thanks. I’ll read all that. Bunsen- I remember that! So glad you are OK. This thread is SO great, my go-to resource. </p>
<p>I’ve never had a stress test/cardiogram – no doctor has ever recommended one (for me or for my husband). I don’t know if it’s that we’re not old enough yet or we have bad doctors or we have none of the indicators to suggest we need something. We’re both in our mid-fifties. I’m less worried about me than my husband, who is not in shape, a little overweight, borderline cholesterol and has a high stress job. At what point does one get these tests?</p>
<p>Mine was recommended by a cardiologist to whom I was referred by my GP after I started experiencing unexpected extremely high (for me) blood pressure. </p>
<p>Thanks, MOfWC. I think I beat the speed record, according to the ultrasound tech who was doing the testing. :)</p>
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<p>I would go to the advanced cholesterol testing at the point where his doc is pitching a Lipitor prescription. “Borderline cholesterol” may or may not be something to worry about, depending on the larger context. The drug company marketing has made treating the cholesterol number the end all and be all, with little or no evidence that lowering cholesterol numbers improves health (for many people).</p>
<p>If someone is not in a high risk category (a real high risk category, not just “borderline cholesterol”) and not experiencing any symptoms, there’s probably no good reason to hit the panic button and start doing a ton of testing.</p>
<p>I think he’s just under the level that leads to drug recommendations, and his doctor did not prescribe drugs for him. No symptoms – he handles his stress very well; blood pressure is fine. He’s seeing a new doctor next month, one who seems to like tests more than our old doctor, so we’ll see what happens. I saw this doctor last year, and while I had to give seemingly huge amounts of blood for all sorts of tests, no stress test was ordered. But I’m thin, exercise a lot, have low blood pressure and low cholesterol – and no family history, either. </p>
<p>I can’t help worrying a little bit, since you hear so many stories of men dropping dead of heart attacks in their 40s and 50s (good friend of mine just died of a heart attack at age 54, but he was physically a mess).</p>
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<p>Here’s a quote from Dr. Davis in the comments:</p>
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<p>Very interesting.</p>
<p>I think ordering a cardiac stress test would be very unusual unless the doc had significant reason to suspect problems – either from symptoms or striking test results. Put it this way… you are going to get prescriptions for Lipitor and blood pressure medication long before you’ll get a stress test!</p>
<p>If you want a good snapshot of coronary artery disease risk (and risk of diabetes), look at triglycerides and HDL plus the number of LDL particles from the NMR Lipoprofile cholesterol test. High triglycerides, low HDL, and large LDL particle numbers are high risk and generally go hand in hand as the classic markers of metabolic syndrome.</p>
<p>A simple reminder to everyone concerned about heart attacks. In the event that you know something is obviously wrong such as unusual pressure in your arm or something else that’s obvious, you need to go to a hospital that has a cardiac catheterization lab so they can do the diagnostics and insert a stent or do other interventions if needed. Time is critical in these situations. The quicker the intervention the less longterm damage to the heart from the event. Not all hospitals have these labs and the time you spend being transferred is avoidable if you go right to a hospital with a cath lab. Know in advance which hospital you would go to. </p>
<p>Also, many heart episodes are preceded by a period of not feeling well or just not feeling yourself. It may be worth going to the doctor for an exam if you sense you are off. </p>
<p>Michael. Does your doctor do these annual exams because you are symptomatic or at risk for heart disease? I can’t imagine that MOWC doc would recommend/approve of this level of testing if she doesn’t have familial risks or other identified risks. </p>
<p>MOWC. If you are very concerned, I would recommend getting seen by a cardiologist for an opinion and not your primary care doc. </p>
<p>peacefulmom, I am not symptomatic. I do, however, have a family history of cardiovascular disease with my maternal grandfather who died at 65 from a massive heart attack. I also have a very slight heart murmur. I started getting the stress tests in 1999, at the age of 46, because my cycling training can often put tremendous loads on my entire cardiovascular system and I wanted to be sure that there was nothing going on - blockages, electrical anomalies or valve leakage - that could result in nasty surprises on those occasions that I’m doing extended hill climbs in 90 degree heat with my heart rate at 90% of my measured max, occasionally hitting 95%. The intensity of some of my cycling training coupled with the history and murmur is what drives my desire to have medically supervised testing. My cardiologist, who is conservative by nature and not a proponent of unnecessary tests, takes all of this into account in ordering the tests. In addition, in his test orders, he specifies that unless during the test it becomes medically contraindicated, I am to be allowed to continue until I want to stop. He does this because under the normal medical testing protocols, 220 - age is used to determine max heart rate and the test would normally be stopped at 85% or 90% of max, if memory serves me right. That formula would have me stopping at 136 or 144 bpm which is a laid back, relaxed work zone for me when I’m on the bike. While my doc says that is adequate for medical testing purposes, it doesn’t meet my objective of simulating the stresses I experience on the bike, so he indulges me and let’s me continue. I normally stop once I am breathing sufficiently hard that I am gasping for air and have been in that zone for about a minute.</p>
<p>In my experience, getting insurance company approval for the Ultrafast Cardiac CT is more difficult than for a stress test. To get mine, I needed to be able to articulate an acute symptom. That was many years ago and perhaps things have changed. At the time, I was experiencing chest discomfort which ultimately my cardiologist and I concluded was due to job related stresses. </p>
<p>And I agree with you that a cardiologist is much better suited to ordering and reviewing the stress test than a GP. I’m fortunate that my insurance allows me to go direct to a cardiologist without a referral. It’s a Direct Point of Service HMO plan. The typical HMO plan requires a referral which can complicate things a bit.</p>
<p>I don’t have any specific concerns other than exactly what Michael said- I work really hard sometimes in training and racing. I do have some family history of cardiovascular disease. I am seeing a real decline in my running ability (certainly could be just aging) and how I feel. I suspect I’m fine, but my national-class runner friend who is 73 had NO symptoms other than some crappy races and it turned out he had a complete blockage in one artery- they described it as like a string tied around a noodle. It just made me wonder how you would even know…</p>