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Re: Coronary Calcium Score [TJ56] [ In reply to ]
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TJ56 wrote:
EyeRunMD wrote:
Wow TJ56, that is a great story! You have likely helped to save your friend’s life by making him aware of this issue, and then him taking the next steps to be evaluated and treated. Major kudos to you!


Just got back from the hospital where I visited my friend who had a triple bypass on Friday. I posted earlier that his very quick journey started with the coronary calcium score (he was >1000). He looks really well considering they just cracked his chest and redid some plumbing. It was very sobering for me seeing him there and really makes me appreciate how I and ST (by getting me to get the test) possibly/probably gave him many more years with his family and friends and he didn't end up on a thread here about someone dying in a swim.

I’m glad your friend is doing well. Thank you for the update
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Re: Coronary Calcium Score (update) [dtoce] [ In reply to ]
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In 2022, I experienced "walk-through phenomenon angina," which was chest pain associated with exercise that went away when I slowed to a walk. I would then be able to continue my runs. I talked to a cardiologist friend, who suggested that I was at the right age (50). The basics of the story is that in 2022, I returned a calcium score of 323, but coupled with an stress test in which I ran 12 minutes (and could have gone longer on the treadmill), I had a small chance of an MI, and I started taking statins and aspirin. In March of this year, I had a perfusion test, which showed a blockage of the LAD, so a catheterization was scheduled. On March 28, I had two stents placed in the LAD. Things have gone pretty well since then, and I am back to running and swimming, though both are a bit slower than where I left off from early 2022 when all this bollocks started.

Last week, I helped perform CPR and external defibrillation on man in his mid-50's who collapsed due to cardiac arrest while exercising. By the time I arrived at the scene, my staff had started CPR and had administered a shock. I stepped in and resumed several cycles of compressions, interrupted only by further analysis by the AED. I resumed compressions on the patient, who by this time had agonal breathing: he was gone. EMS arrived and took over care, recaptured a pulse, and transported. Reports after the fact indicate that the patient survived. The cardiac arrest was caused by severe blockages (up to 98%) in all three major coronary arteries. His feedback mechanism was poor and he, like many other men in his 50's, had no prior symptoms until his sudden collapse. Multiple stents were placed. Had this patient not been in a location with trained personnel, his chance of survival would have been less than 10%. At last report, he was talking and somewhat lucid, but had no memories of the incident.

The intersection of two life stories here is interesting. Because I have been active and healthy for my whole life (competitive swimmer since the age of 7, college swimmer, 9 x marathon and 3 x IM finisher, BMI < 25, low BP, no smoking, infrequent drinking, etc), this was chalked up to genetics, which is the same as with the patient.

I encourage men in their late 40's and early 50's to consider comprehensive tests for heart disease. These may be expensive, but are worth it as diagnostic which can lead to preventative measure. I was able to avoid the MI that I was genetically destined for. I encourage everyone to be trained in CPR, and if available, the use of an AED. The patient was destined for his MI and cardiac arrest, and I am glad that my training and the training of my staff gave this man a chance.
Last edited by: 140triguy: Dec 21, 23 6:52
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Re: Coronary Calcium Score (update) [140triguy] [ In reply to ]
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140triguy wrote:
I encourage men in their late 40's and early 50's to consider comprehensive tests for heart disease. These may be expensive, but are worth it as diagnostic which can lead to preventative measure. I was able to avoid the MI that I was genetically destined for. I encourage everyone to be trained in CPR, and if available, the use of an AED. The patient was destined for his MI and cardiac arrest, and I am glad that my training and the training of my staff gave this man a chance.

Great story on so many levels. Good for you and your self-care!

Huge thank you, on his behalf.
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Re: Coronary Calcium Score (update) [140triguy] [ In reply to ]
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140triguy wrote:
In 2022, I experienced "walk-through phenomenon angina," which was chest pain associated with exercise that went away when I slowed to a walk. I would then be able to continue my runs. I talked to a cardiologist friend, who suggested that I was at the right age (50). The basics of the story is that in 2022, I returned a calcium score of 323, but coupled with an stress test in which I ran 12 minutes (and could have gone longer on the treadmill), I had a small chance of an MI, and I started taking statins and aspirin. In March of this year, I had a profusion test, which showed a blockage of the LAD, so a catheterization was scheduled. On March 28, I had two stents placed in the LAD. Things have gone pretty well since then, and I am back to running and swimming, though both are a bit slower than where I left off from early 2022 when all this bollocks started.

Last week, I helped perform CPR and external defibrillation on man in his mid-50's who collapsed due to cardiac arrest while exercising. By the time I arrived at the scene, my staff had started CPR and had administered a shock. I stepped in and resumed several cycles of compressions, interrupted only by further analysis by the AED. I resumed compressions on the patient, who by this time had agonal breathing: he was gone. EMS arrived and took over care, recaptured a pulse, and transported. Reports after the fact indicate that the patient survived. The cardiac arrest was caused by severe blockages (up to 98%) in all three major coronary arteries. His feedback mechanism was poor and he, like many other men in his 50's, had no prior symptoms until his sudden collapse. Multiple stents were placed. Had this patient not been in a location with trained personnel, his chance of survival would have been less than 10%. At last report, he was talking and somewhat lucid, but had no memories of the incident.

The intersection of two life stories here is interesting. Because I have been active and healthy for my whole life (competitive swimmer since the age of 7, college swimmer, 9 x marathon and 3 x IM finisher, BMI < 25, low BP, no smoking, infrequent drinking, etc), this was chalked up to genetics, which is the same as with the patient.

I encourage men in their late 40's and early 50's to consider comprehensive tests for heart disease. These may be expensive, but are worth it as diagnostic which can lead to preventative measure. I was able to avoid the MI that I was genetically destined for. I encourage everyone to be trained in CPR, and if available, the use of an AED. The patient was destined for his MI and cardiac arrest, and I am glad that my training and the training of my staff gave this man a chance.


Bravo to you-for multiple reasons!

The best thing one can do to 'pay it back' to the world is learn CPR and be ready to help others if a situation were to occur where first responders are needed.
Major kudos for not only getting yourself put back together and now into a lower risk group, but also with helping to save that man's life.


The risk of an event from CAD for the general population in the US is ~200/100,000.
Based on athlete data (*Creswell), it's about 2/100,000 for dying in an endurance event.

Far, far less, but still not 0. I often say 'you can't change your age or your genetics'. At least coronary calcium scoring is a mechanism of determining how much risk there actually is.



With time and training, you'll be right back to your fitness level and beyond-140triguy.
Best to you-

What Endurance Athletes Need to Know About Heart Health - Slowtwitch.com
Last edited by: dtoce: Dec 20, 23 9:23
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Re: Coronary Calcium Score (update) [dtoce] [ In reply to ]
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A 630 CCS wasn't what I was hoping for but now that I've seen it, what are my best next steps?


I'm a 70 year old long time endurance exerciser who bikes regularly in the warmer months and cross country skis as well as Concept II ergs throughout the winter. I've turned to marathon canoe racing for the past 5 years. My diet has been near vegan for the past 5 years and annual lipids testing has usually put my total cholesterol at ~160, LDL in the low 80s although the calculated value was 106 on my most recent test and HDL ~ 52. My Apo-B was 66mg/dl last year. My blood pressure is typically ~ 116/78 with no medication needed. I've experienced some disturbing increasingly noticeable paresthesia symptoms especially from the knees down over the past few years. I've never been prescribed a statin but from what you've mentioned previously assume a low dose of rosuvastatin would be appropriate as a starting point.

I don't presently have a cardiologist and perhaps finding one is one of the most appropriate first steps.

Ought I press for an exercise stress test? CT angiogram? Any other thoughts going forwards?

Thanks so much for your generous participation on this thread.

Hugh

Genetics load the gun, lifestyle pulls the trigger.
Last edited by: sciguy: Dec 29, 23 7:47
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Re: Coronary Calcium Score (update) [sciguy] [ In reply to ]
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sciguy wrote:
A 630 CCS wasn't what I was hoping for but now that I've seen it, what are my best next steps?


I'm a 70 year old long time endurance exerciser who bikes regularly in the warmer months and cross country skis as well as Concept II ergs throughout the winter. I've turned to marathon canoe racing for the past 5 years. My diet has been near vegan for the past 5 years and annual lipids testing has usually put my total cholesterol at ~160, LDL in the low 80s although the calculated value was 106 on my most recent test and HDL ~ 52. My Apo-B was 66mg/dl last year. My blood pressure is typically ~ 116/78 with no medication needed. I've experienced some disturbing increasingly noticeable paresthesia symptoms especially from the knees down over the past few years. I've never been prescribed a statin but from what you've mentioned previously assume a low dose of rosuvastatin would be appropriate as a starting point.

I don't presently have a cardiologist and perhaps finding one is one of the most appropriate first steps.

Ought I press for an exercise stress test? CT angiogram? Any other thoughts going forwards?

Thanks so much for your generous participation on this thread.

Hugh


It is alarming to see these high numbers pop up. Definitely talk with your pcp and look forward to a likely cardiology referral

dtoce is the expert in these matters but I‘ll tell ya what advice was given to me after my high calcium score was obtained.

My primary care doc immediately put me on atorvastatin and a baby aspirin, and I was scheduled for a stress test and echo by cardiology. Ends up, a week before my treadmill stress test, I developed a calf strain and could not run. So, the cardiology office rescheduled me for a month later and said if I still could not do the treadmill test then they‘d schedule me for the non-treadmill version. Well, after another few weeks my calf was not any better and I was getting more paranoid I was going to have a heart attack any day now, so the cardiologist ordered a CT angiogram. That helped with more clarity for how bad, or not, my coronary arteries were after getting my high calcium score.
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Re: Coronary Calcium Score (update) [sciguy] [ In reply to ]
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sciguy wrote:
A 630 CCS wasn't what I was hoping for but now that I've seen it, what are my best next steps?

Hugh


This has become a very long thread and it may be best to summarize what to do for those with markedly elevated coronary scores...


Since you need an order to get this test done, the first step is always to discuss the results with the provider who ordered the test.

Guidelines suggest all patients with coronary calcium scores over 400 begin ASA (aspirin) 81 mg daily and start statin to achieve a goal of an LDL<70.
Patients should also get an ischemic evaluation (stress test) to evaluate for critical blockages in the coronary arteries.
This is done because there is significantly elevated risk in the group with marked coronary artery calcification-even in the absence of any symptom of concern.

Risk is also concurrently assessed using the MESA risk calculator and ACC risk estimator.

https://www.mesa-nhlbi.org/...Score/RiskScore.aspx


https://tools.acc.org/.../calulate/estimator/




These are a few graphs showing the risk :







Dr. Aaron Baggish did find that there is a group of endurance athletes that is paradoxically low risk and wrote an article about these patients.
https://www.ahajournals.org/...LATIONAHA.117.028750

This was the definitive article from the ACC regarding Coronary Calcium Scoring and Risk which came out in 2019
https://www.acc.org/...-cardiovascular-risk

Once a high score is obtained, patients should obtain a cardiology consult. It is always prudent to maintain an active lifestyle without pushing it from an activity level until the consult is obtained and treatment and testing is scheduled.

Good luck.
D. Toce MD FACC
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Re: Coronary Calcium Score (update) [dtoce] [ In reply to ]
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Thanks so much for the, as always, reasoned and very helpful reply. My GP and I discussed the results yesterday and he's put me in charge of finding a sports oriented cardiologist. I'm lucky enough to have a good friend in the medical field who is helping me with that.

So I take it that my killer 4 X 8 minute super intense erg intervals ought to go on the back burner until I'm cleared but my long zone 2 bouts are probably reasonable and will keep me sane.

I'll report back to the thread as things progress.

Hugh

Genetics load the gun, lifestyle pulls the trigger.
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Re: Coronary Calcium Score (update) [dtoce] [ In reply to ]
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Dr. Aaron Baggish did find that there is a group of endurance athletes that is paradoxically low risk and wrote an article about these patients.
https://www.ahajournals.org/...LATIONAHA.117.028750//


That was an interesting study, but as it says, dont take anything conclusive away from it. I have always wondered if the higher #'s of CAC scores in athletes, wasn't from the increased amount of food that an endurance folks eats. I mean food is a big input along with genetics, so someone that eats twice or more food, wouldn't that be a bigger input(if negative)?

I mean diet if often used to help correct scores(cholesterol mainly), so food, what kinds, and perhaps amounts will be inputs when they finally sort out all the studies, and bring new ones online..
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Re: Coronary Calcium Score [dtoce] [ In reply to ]
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Just wanted to drop back in and say thank you to everyone again. I've been on the low dose of Crestor for four months now and had my bloodwork done for a new cardiologist who is more on top of research and who understands athletes.
My LDL dropped from 90 to 55! Pretty stoked with that. He ordered an ANA blood test for inflammation factors and while I do have a "fine, dense speckled pattern" I don't have any rheumatoid factor involved. So, we still have some puzzle pieces to figure out in terms of contributing factors to my heart disease, but I will take the W with the results of the statin.

I very much appreciate everyone who chimed in--looking at you too, Monty--your words matter.

xoxo

Meg
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Re: Coronary Calcium Score [MeggieB] [ In reply to ]
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Thanks for the update. I’m glad the testing is moving along and you are responding well to the Crestor
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Re: Coronary Calcium Score (update) [sciguy] [ In reply to ]
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Here's my quick update. I'm a 70 year old, very active cross country skier, cyclist and fairly new marathon canoe racer. My lipid numbers have been very good for at least the past 5 years but in running all my numbers through an ASCVD risk calculator I was surprised to see it recommend a statin. My GP who knows my eating and exercise habits had never brought this up to me but when I asked him for a prescription for a self pay coronary calcium score to help me decide if it actually made sense to go on a statin he said sure. Just before Christmas I had a scan done, figuring it would come in with a nice reassuring low number. The 630 was an expected surprise that caused a good deal of ramped up anxiety. It took a couple of months to see a cardiologist. Based on my CCS we decided a low dose of rosuvastatin was appropriate to harden down any soft plaque that might be lurking and an exercise stress echo was scheduled.

For the stress echo I was a bit surprised when the doctor "calculated" my maximum heart rate based on the old 220-age equation rather then the more modern equation for men that runs something like 207- (.67X age in years) or even higher max I've hit several times in the past year. Long story short, I never broke a sweat and could easily gone one many more minutes. My ECG and echo looked fine with no ST depression. I was told not to worry, call if things went south and come back in a year. To be honest I would really have preferred to competed the treadmill test to exhaustion but do understand they don't want patients keeling over on them. I was also advised to have another lipid panel in a few months to see the effect of the rosuvastatin. I resumed quality intervals on the erg and am now nearly back to last year's fitness after laying of intervals for much of the winter. Zone 2 may lay a nice base but isn't the icing on the cake.

YMMV,

Hugh

Genetics load the gun, lifestyle pulls the trigger.
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