It is good you have connected with a cardiologist, but not all are equal-as is the case with many, many doctors...You still need to work with a physician that you trust and hopefully will give you excellent medical advice. In a best case scenario, you get someone you get along with also and who practices sound 'evidence based medicine'. It's quite variable in the real world and patients often DO need to seek second and third opinions until satisfied.

I often encourage any patient not happy with my advice to seek another MD opinion as I am confident in what I'm telling them but sometimes there is simply not a good fit with style or personality. By the same token, I have discharged patients from my practice for noncompliance, verbal abuse or drug seeking behavior. I expect questions and we need to take the time to answer them. This is the 2nd biggest reason for my being late walking into the room of outpatients in my office (*#1-unexpected medical issues which were more serious and required extra time/attention). It's most definitely a box of chocolates.

Keep at it until you find knowledgeable doctors you trust.


You have raised several points that I have seen numerous times before with my patients:

1)You have now been diagnosed with heart disease=CAD, plaque in your coronary arteries, in particular the LAD, the largest of the heart vessels. This happened despite being in good shape and having good genetics.

2)This has impacted your insurance status.

3)There is now a worry about what you can do with the condition, despite being told that you are OK.

In response:
1) CAD is more prevalent than anyone thinks. It's not a 'widow maker' until it's a critical lesion, but that is the vessel that is the biggest and supplies the most area of heart muscle. Although you already now know most of this-
https://www.slowtwitch.com/...art_Health_7911.html

2) Ask your MD to write a letter to your insurer summarizing your test results, functional capacity and cite the meds being taken to lower your personal long term risk. It may or may not help. I fight with insurance companies every day. Worse for me as I live in the 'Insurance capitol of the world'. Blech...

3) In general, you should be able to do all your usual activities, but again, work with your doctor for your specific issues. Sometimes it's best to do a maximal exercise treadmill test to prove that intense exercise is not a risk behavior.


It's hard to be told you have new diagnosis of any medical condition. Harder when it's heart disease-the number one killer. When I do tests on patients and they come out abnormal, I'll sometimes ask them if they are a "glass half full or glass half empty" sort of person, especially if it's early in our relationship. Finding out you actually have CAD is a startling finding for many and one that is very often missed. I think it's best to find out early and know so that you can be more sensitive to any new issue that might arise and more importantly, be on meds to lower the long term risk. The goal is always to maximally enjoy life as safely as possible. There are no guarantees in life so being able to be relatively protected is somewhat comforting.

As an aside, if you've ever had a CT of the chest (for a reason other than looking for CAD), the report may mention if there was "coronary artery calcification" which means that plaque has developed in the heart arteries to the point of showing up. It is diagnostic of the presence of CAD, not the severity. Non-critical plaque can look the same as critical plaque on a CT scan. "Dense or extensive" plaque can still be noncritical and "mild" can be very, very severe. Treatment is aspirin and getting the LDL to below 70, almost always with a statin since the liver makes too much cholesterol in most people. Some people need extra testing to prove low risk. Work with your doctor on this, and know the types of things that would require extra testing.

You had a CTA, which gives ranges for plaque burden. A cardiac cath uses contrast and is the gold standard for assessing severity in % but it's still a guess. Presently, there are better tools like flow-wires and intra-vascular ultrasound of the coronary vessels which can give better functional flow assessments and %'s. Noncritical is usually < 70-80%. When lesions are in this ballpark, we do the flow-wire assessment to determine if a PCI (percutaneous coronary intervention) is needed with a balloon/stent.

Family history becomes irrelevant once diagnosed as you now have it. Noncritical plaque is something to be aware of but not fear. "Nothing is wrong with you at all", except for the fact you have noncritical CAD also...and all that entails...I have tons of patients who are out doing all sorts of intense physical activity with heart disease. Some with noncritical CAD, some who have had PCI or CABG, some who have had valve surgery. And I have some (far fewer) who are advised not do to physical activity above a threshold.

My advice, as always, is to work with your doctor(s).

*edited to add:
I'd argue that by connecting with a cardiologist and being treated appropriately, your risk is much lower than the general population including athletes. Most patient with events *(MI, sudden cardiac death/cardiac arrest) have underlying disease and do not know it and are not on medication. When Tom ran his 10K PR, he had multi-vessel CAD, but was unaware of -but when he DID develop some symptoms, he did not ignore them but did the right thing and got checked. (sorry to use you Tom, but I knew you'd understand coming from a medical family)


Best of luck in your quest for health and fitness.

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I'm happy to be used. :=) But, you know that. It's my best trick, anyway.

Always good to see you 'round... Doc.