Heart Health Program

The risk of getting a heart attack is very low and if we start screening ourselves at 35 years that will be an excellent baseline of our heart function.
When we repeat these 3 basic tests for the heart every five years, we can compare these tests with our heart health 5 years ago and if there are any changes, then we can pay more attention and get more testing if needed or take steps to reverse those changes.
Heart Health - TMI

First two tests are absolutely simple tests and the third test itself is also noninvasive where we hang water and put color/dye in that water which goes in the blood and goes to the heart. Then CAT scan takes quick pictures of the heart arteries filled with colored water. Software makes a three-dimensional image and if there is any blockage we can clearly see it. If you really look at it, you can clearly see that they smoothly fill up with the blood. This means, there is no blockage.
If all these three tests are normal which tells you different things about the heart, then you absolutely have no risk of getting a heart attack in five years.

Seriously, you are not going to get it, almost guaranteed!
So, if arteries are clean today, then after five years you may have arteries which are about 20% blocked. Then you can take steps to reverse that blockage or slow it down.


What is the most important thing we want to know from an echocardiogram?

The most important fact about EKG that we will not realize is that it is like a fingerprint. It remains the same every month. We do it every six months, we do it every year whenever we do it, and it will look exactly the same. So, any change from the baseline, so called ‘baseline’ will immediately make us doctors jump up because it has changed!

Second thing, EKG immediately can tell us the rate and rhythm. Rate is usually 72 beats per minute and rhythm is very, very regular. If you look at the two tallest and take a scale, you will see the distance between is always very equal.

The master electrical switch which is SA node in the heart, when it beats or when it depolarizes or when it sends out electrical signals, it sends out electrical signal very rhythmically and you have to understand for a heart to pump to function, it has to contract and relax in a very coordinated manner, very rhythmically. Believe it or not, EKG can also tell us if we had a heart attack in the past. It definitely tells us if we are actively having a heart attack, but we are not talking about EKG during the chest pain or so-called ‘heart attack’.

You may not focus on this; we get our EKG and forget about it. We cannot even find it the one we had two years ago or five years ago. But, you have to understand the comparison between different EKGs and the past EKG. It is the single most important medical factor that helps us to focus on any early changes.

The changes may be there, but they may be very early changes and they may still fall within the normal change from the normal baseline. But then, if your EKG is same every year and now if there are some changes, then we need to figure out why this has happened.

EKG is one way we can find out whether high blood pressure is happening in a year or two or has been there for 15 to 20 years. EKG will clearly show this. There are definite changes in the EKG which shows that high blood pressure has been there for a long time.
Again, for such changes to happen, the most important reason is high blood pressure. You have to have high blood pressure for a long time i.e. for 10 to 15 years before such changes happen. They happen very gradually, very slowly.

While you do not have to understand but as years of high blood pressure progresses without taking any medication, R wave in the EKG becoming taller and S wave in the EKG becoming deeper, there is what we call electrical axis of the heart which we can calculate from the EKG and it also starts changing.

EKG can tell us tons of things, but these are the most important things we want to know. Once again, the most important thing we want to know is any change from our normal year-to-year EKG.

2-D Echocardiogram/Ultrasound of the heart

What is the most important thing you want to know from the echocardiogram?

One thing which is very obvious, we all want to know what our Ejection Fraction is. Ejection means- what you kick out or what you reject.
When the heart pumps, it kicks out or pumps out the blood to the rest of the body and it is not completely empty but it kicks out about 70% of the blood which goes through the rest of the body. Blood pressure rises to 120 and then as the heart relaxes, blood pressure falls down to 80 mmHg and the heart starts filling up with the blood.

This cycle continues. Ejection fraction is very important for all of us. If our ejection fraction is 30%, then we cannot walk from one room to another without feeling very short of breath and our life expectancy is few years only, unless we do some major intervention. Such a person will actually meet the criteria for heart transplant also.

We want to know the function of the valves. Heart has four valves which make sure that the blood always goes in one direction. It does not leak back. It closes and opens smoothly. An ultrasound can tell us right away, especially, the color ultrasound can even tell us any leakage or any turbulence in the blood which should not happen in a normal healthy heart.

Third important thing that we want to look for and it should not be there, is a thickening of the heart muscle walls. The muscles becoming thicker and stronger is good for our hands and feet or upper extremity and lower extremity, but it is not good for our heart, because heart has a very limited blood supply and if anytime we increase the thickness of our muscles as we do by exercising or weightlifting, then blood supply also catches up. But, that is not true for the heart. So, what we are looking for is a normal thickness of the heart muscle and if the muscle is thicker than normal then the most important reason is usually the high blood pressure.

CT Angiogram

What is the most important information you want from CT angiogram?

We already have huge information from EKG and ultrasound which can be very comforting, but fact is none of these tests tells us the blood supply of the heart. They tell us about the electrical rhythms. They tell us about the mechanical function of the heart.

Heart has only three tubes, actually two tubes. One right heart artery is called the Right Coronary Artery and the left heart artery is called the Left Coronary Artery. Left Coronary Artery divides into three, so traditionally we say the heart has three arteries which supply all the blood to the heart and any cut off from any of the branches will lead to heart attack.

Again, anything can happen in the movies but in real life, things happen very slowly. Heart arteries start getting blocked with some deposition of cholesterol plaques in the wall of the arteries or the tubes and slowly, slowly they become narrower and when the blockage is more than 70%, we start having chest pain. Anytime our heart gets stressed out.

Suppose we walk or run 2 kilometers every day. So, our heart becomes used to that. But, suppose we chose to run 5 kilometer and we have a blockage of 70%, then we definitely start having chest pain after we have run for 2 kilometer because then heart cannot compensate any extra effort and it will not be able to meet the increased demands of heart muscle and we start having chest pain or a heart attack.

Most important thing we really want to know is the percentage of blockage.

As blockage happens over years from 20 to 30% will take probably three to five years, from 30 to 50% will take probably another three to five years, and then blockage proceeding to 70% will take about 10 to 15 years.

Most of us have a very similar lifestyle and same kind of diet, so we can draw a straight line based on what is happening every few years and unless we change, we make some kind of intervention whether by diet, by exercise, by mediations, or by medical technology obviously in consultation with a cardiologist, heart doctor. Then, we can slow down the blockage or even reverse it and most important medication we use for that is the cholesterol lowering medication.