The Heart of the Matter

So, in November last year I finally went to a new primary care physician to discuss my long-running high blood pressure issues.  I'd been putting it off for a few years because I didn't want to get into things with yet another new doctor after my previous two both left New York City...  

But Leena had gone to her for a skin issue and really liked her, so she talked me into going.  I actually picked this doctor because I knew her name at the clinic since she was well established there when I first started going for another doctor in 2014.

So, Dr. A. talked to me, took some blood and later when we followed up via video call (coronavirus pandemic, you know...) she changed my high blood pressure medication and put me on a statin for cholesterol, which she described with "sky rocket".  The new medications were giving me headaches, but as they were lowering my blood pressure she didn't want to change them without my seeing a cardiologist first.

When I saw the cardiologist, Dr. T. he didn't believe me that the medications were causing the headaches, which started the day after I started those medications, but was willing to change the prescription to ease my mind at a minimum. 

Dr. T. was concerned about my state of health, my long running high blood pressure, that I got out of breathe when I was active, and my family history, since my father had a heart attack and quadruple bypass at 64 years old and one of my grandfathers died of a heart attack at 62 (granted, he'd been a lifelong smoker, which wasn't my case).  Dr. T. said things like my father's heart attack usually started showing signs about fifteen years in advance, and that puts me easily into the beginning of that 15 year range compared to my father's heart attack...

Dr. T. also scheduled me for a CAT scan, a "CTA Coronary Artery" at the hospital for a week and a half ago.  I went for that, which involved spending an enormous amount of time waiting my turn, and then feeling like I peed my pants when they injected me with the radiocontrast dye (I didn't, it just felt that way when the warmth spread through my body, getting to my crotch region...)

And Monday last week I met with Dr. T. at his office where he reviewed all the images from the CAT scan and some other ultrasound images done that morning.

He then told me that the scans of blockage scored me in the 89th percentile for men aged 51.  Um, ok.  I had to ask if that meant 89th percentile good, or 89th percentile bad.  He then clarified that it was bad.  So, these are like golf scores, a lower number is far better...  It turns out I have more blockage in my heart's arteries than 88% of men aged 51.

Well, I figure that's trivial to beat.  Later this year I'll turn 52, invalidating the whole statistic.  

Dr. T. recently uploading the results to the MyChart system so I could read it and here's an excerpt of the key parts.

1. The calcium score is 119 in the 89th percentile for age, gender and ethnicity.

2. There is no calcified aortic plaque.

3. Normal LM. 

4. 25-50% stenosis of the proximal LAD due to mixed plaque with a high risk feature of spotty calcification. Normal remaining LAD.

5. 50-69% stenosis of the ostial to proximal large high D1 due to mixed plaque with a high risk feature of low attenuation plaque.  50-69% stenosis of the mid D1 due to non-calcified plaque. Norma distal D1. Normal branch of D1. 

6. <25% stenosis of the proximal LCx due to non-calcified plaque.  Normal remaining non-dominant LCx. Normal OM1.

7. Normal proximal RCA. Mid RCA is ectatic with 50-69% stenosis in the mid segment due to mixed plaque with a high risk feature of low attenuation plaque and spotty calcification. <25% stenosis of the distal RCA due to mixed plaque. Normal RPLA and RPDA.

I sent this to my wife with this description, including links to Wikipedia:

Here's a Wikipedia article that explains the arteries in question.  

And here's a grabshot of the vector drawing in the Wikipedia article:

Note that the picture is reversed, showing the patient's left side on the right and right side on the left.  This is because the picture is drawn the way a doctor would see it looking at the patient.

In the picture you can see the LAD mentioned in the doctor's #4 item.  It's on the right side of the picture.  This is 25-50% blocked (I'm not sure why there's a range that size, whether it's because different parts of the artery are blocked different amounts, or because that's as accurate as the scan can get).

His #5 item refers to D1, which is on the lower right side of the picture.  This is blocked 50-69%.

His #6 item is LCx which is in the middle of the right hand side of the picture.  This is blocked less than 25%.

His #7 item is RCA which is on the left middle side of the picture.  This is blocked 50-69%

For now Dr. T. has increased my blood pressure and cholesterol medications as well as including a new one, a beta blocker.  He suggested (was it a suggestion or an order?) a no cholesterol diet.  And I'm to follow up with him later this month to see where to go from there.

He talked about maybe scheduling another procedure to look closely at the blockages with a camera inserted up in there, and possibly inserting stents.  I assume it wasn't an immediate life threatening emergency or he would've done more than sending me home with some medication prescriptions for now.

Dr. T. also emphasized my need to get a sleep study from a sleep specialist.  I was lazy about scheduling that, with the idea that it would be a lot less stressful to deal with one specialist's area of my body at a time.  

At home we're trying to deal with my diet.  I need to be more careful about not cheating as much, since now the damage that's doing is more concrete and less abstract.  But convincing Leena to change how she's cooking for me is harder because she doesn't want to believe she's been cooking food that's unhealthy for my heart as it is.  She wants to think she's been doing everything perfectly.

I also made an appointment with the sleep specialist for next week...