Cardiac Hill

[Jamie]

Fingers crossed!

[kdh]

Kim, speaking of "freeing," does one go "commando" while wearing a kilt? Seems appropriate.

Tim, best wishes for a speedy recovery.

Lin, Eric, just curious, do you know the genetic basis for athletes with heart disease? From what I know high blood levels of something called Lp(a) is the only one known, and is hugely under-appreciated by doctors. Also, my view is that our current practice of just screening for high LDL and waiting for heart attacks to indicate high levels of plaque is asinine. I'm a fan of calcium-scoring CT scanning to measure plaque levels before they become catastrophic. Thoughts?

[BeauV]

Kim, speaking of "freeing," does one go "commando" while wearing a kilt? Seems appropriate.

Tim, best wishes for a speedy recovery.

Lin, Eric, just curious, do you know the genetic basis for athletes with heart disease? From what I know high blood levels of something called Lp(a) is the only one known, and is hugely under-appreciated by doctors. Also, my view is that our current practice of just screening for high LDL and waiting for heart attacks to indicate high levels of plaque is asinine. I'm a fan of calcium-scoring CT scanning to measure plaque levels before they become catastrophic. Thoughts?

Keith, go have a look at what HeartFlow is up to http://www.heartflow.com I think you'll find it's an interesting use of that CT data. BV

[Lin]

Tim's surgery is booked for approximately 1 pm today. I expect with the valve replacement and all the bypasses, that the surgery will take about 5 or 6 hours. Tim's family are going to contact me when it is over, and I will keep you posted. I expect to go see him tomorrow, briefly, and I can call at any time to see how he is doing, which is reassuring. I hope that my golfing and sailing buddy is back on the ocean and on the greens in three months time. I have a few months to improve my driving so I can out-drive the ball. In the meantime lots of walking will be his most important activity.

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kdh, that is a very good question. I would say that approximately 35 - 40 % of our patients that we find with heart disease (confirmed by angiogram), requiring one of the the three branches of treatment, have "normal" cholesterol levels. Having a normal cholesterol level is not insurance that one does not have heart disease. Having high cholesterol levels does not mean one has or will develop heart disease (I am talking about Coronary artery disease here, as opposed to other conditions of the heart ie: involving electrical conduction and valves etc)
The three treatment branches are generally - medical, surgery or angioplasty (stent). I would say that about 30% of our patients do not have any of the "known" risk factors for heart disease.

Simply put - there are some risk factors for heart disease that we do not fully understand.

What I have found in the very "young, fit and otherwise healthy" folks with heart disease (in the 45 - 60 age group), is that they tend to be the Type A personalities - very driven, perfectionists,very intelligent and accomplished. Stress management affects inflammatory processes and I suspect this aspect might be part of that equation in this population. Again, lots of people fitting that picture do not get heart disease. I have noticed that this population of people do not often have three vessel disease, but rather have one significant blockage in one artery (usually LAD artery), or perhaps two. Whereas say, Insulin dependent diabetics with heart disease, usually show up as significant blockages in all of their arteries.

Lots of folks are not familiar with the difference between the cause of Type 1 and Type 2 diabetics, and the difference is significant.

In my opinion what I think is more important than just "cholesterol levels" is the health of the walls of the arteries and the turbulence of blood flow through them. Tension and instability on the walls and cellular components of the arteries is what makes them more susceptible to plaque (cholesterol) build up and plaque ruptures, which is what usually causes heart attacks. Smoking, high blood pressure, diabetes, age, being overweight and or sedentary, genetics, poor stress management, other autoimmune or inflammatory diseases, some chemotherapies or radiation used for previous cancer all can cause inflammation, irritation, wear and tear to the vessels which makes them susceptible to plaque build up and disease.

A heart attack usually occurs when a piece of plaque breaks away from the wall of the inner artery. As the plaque ruptures, the wall of the artery bleeds and a blood clot is formed at the rupture site. As the clot forms and grows, it occludes the flow of the blood through the artery. When the blood supply is stopped altogether because of the clot in the way, a myocardial infarction (heart attack) occurs. That is why taking Aspirin immediately (or daily) is so important> it affects the clotting mechanism just enough so the clot does not form quickly, and that blood can still get though past the area of plaque rupture to a more distal part of the heart muscle.

CT scans are becoming much more popular as a screening tool for heart disease, but they are not a gold standard test. Still, if one has significant or multiple risk factors, or symptoms this is a good starting point to rule out heart disease. There are still some false positive and some false negatives in the results likely running around 10 - 15 %
Exercise stress tests and nuclear medicine perfusion tests also run about a 10-15 % false positive or false negative tests. Some folks think because their ECG is normal that their heart is fine. This can not be further from the truth.
Having an angiogram is currently the "Gold Standard" diagnostic test to determine presence or extent of CAD.

We all learn something as a result of someone we know going through something like this. It is a good stimulus for discussion and prompting us to learn.

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On a very different tack, but related to health care ... some of you know that my best friend's little boy has been battling serious cancer since Feb. this year. He is three years old. His chemotherapy, radiation and surgery are all complete and all scans this week show no signs of the cancer. : )

[Lin]

I just spoke to Tim and he is going under an hour or two sooner than expected. Which means recovery starts sooner, too. Will post an update later. : )

[bob perry]

Thanks Lin. As soon as you know would you please let us know.

I spoke to Tim just as they were cioming in to prep him. He sounded cheerful but that's just Tim. I'd be scared shitless. I am scared shitless and it's not even ME!

I can'twait for the good news. I really want his Les Paul but not just yet.,

[Orestes Munn]

Kim, speaking of "freeing," does one go "commando" while wearing a kilt? Seems appropriate.

Tim, best wishes for a speedy recovery.

Lin, Eric, just curious, do you know the genetic basis for athletes with heart disease? From what I know high blood levels of something called Lp(a) is the only one known, and is hugely under-appreciated by doctors. Also, my view is that our current practice of just screening for high LDL and waiting for heart attacks to indicate high levels of plaque is asinine. I'm a fan of calcium-scoring CT scanning to measure plaque levels before they become catastrophic. Thoughts?

Keith,

No single parameter can ever be more than a noisy marker for the process which buggers up arteries. There is injury to the vessel wall, clotting, deposition of crud, and inflammation, all of which are tightly interrelated by a fantastically complex web of signaling and each of which can look like cause or effect in different phases. Every component is potentially influenced by genetics and environment.

Lin gives a great account of clinical reality.

For anyone who doesn't know, going on the "pump" is a huge deal and my thoughts are certainly with Tim today.

[kdh]

I really appreciate your thoughts, Lin and Eric and Beau. Thanks.

I know some of the details of a bypass and am just awed by the success rate. What humans do for others is amazing. My thoughts are also with Tim that everything goes well.

[bob perry]

Well? God damn it! I'm waiting! I want some news and I want it now.

[kimbottles]

I am waiting too......

[Lin]

I do not expect to hear anything for another hour. I spoke to Bob to reassure him, he is the first person I will call

[kimbottles]

fingers crossed!!

[Lin]

I just phoned Maestro to give him the good news. Tim is just coming out of surgery and he is doing ok. Four bypasses and a new valve. First 24 hours is never a clear, easy path, but all went well with surgery. Hopefully the breathing tube will be out tomorrow. I will see him tomorrow and pass on the good wishes and support of you all.

Lin : )

[Slick470]

Good news! Thanks for the update Lin.

[kimbottles]

phew! Now I can breath again.......

[BeauV]

Lin, thanks for keeping us informed. Wish him our very best! Beau

[Jamie]

Ok, one bridge crossed. Glad to hear the favorable outcome.

[Cherie320]

Lin - thanks for the update and good news. Best wishes to Tim for a fast recovery.

[JoeP]

Thank you very mich Lin.

[LarryHoward]

Thanks Lin

[Orestes Munn]

I hope this is the first of many happy milestones.

[Rob McAlpine]

phew! Now I can breath again.......

This.

[cap10ed]

Wonderful news Lin. I guess we can start that best anchor choice thread now.

[kimbottles]

Lin, when can we call him??
(I have his cell number.)

[bob perry]

Lin:
So what you are saying is that I'm not goiong to get the Les Paul any time soon?
That's just great news.

[Soñadora]

great news.

My dad had a quad bypass when he was in his 70s. It was touch and go for a while from infections, but he's a tough s.o.b.

[bob perry]

I figure I'll call him late thias afternoon. Just to give him shit. He needs shit. Putting the rest of us through this. Not very considerate. Probably thinks it'll fix his golf game.

[Lin]

His breathing tube was taken out out around 3 am, which is a very positive sign. By late this afternoon, hopefully he will be able to talk to you on his phone, Bob. His daughter currently has his phone, so you might get a gorgeous, tall ginger on the phone if you call now. She will not promise you his Les Paul. Best to wait until you get a sleepy, tired, drugged-up Tim on the phone later, to give you his prized guitar. It's a big surgery to recover from, but he was so calm, in good spirits and well prepared going in, that I think he will do well. I am heading down soon to see him soon.

Rick, yes infection is a big concern. Tim knows this, has a great awareness of it and he has good hand hygeine. Getting him back to his home and out of the hospital in a safe and timely manner, is one of the best ways to avoid a nasty infection.

[bob perry]

Lin:
Great idea. Get Tim while he's all drugged up. That's the ticket.

Sounds like all is going very well. Many thanks for your updates.

[VALIS]

Thanks Lin. I've not posted much, but I have been following Tim's progress (and it sounds great!) Please pass along my best wishes.

Tim, if you're reading this, please don't let Bob sneak off with your Les Paul! He's only a bass player fer chrissakes! Lord help us all if he turns into a lead guitarist.