Medical Questions & Answers » Arteries and Veins

Coronary Angiogram – Cholesterol Control

medicalquestions — Mon, 08 Jun 2009 06:00:22 +0000

1. Since angiogram is not a common part of routine health check-up, how does one assess one’s likelihood of having arterial blocks? Is an annual ECG test enough?
2. Anti-Cholesterol drugs – are they safe for long-term use? Do they damage the liver? Are periodic liver function tests necessary? Is it safe to reduce the drugs to half-dose as soon as the cholesterol level is normal?
3. During medical check-ups, are a full Lipid Profile test required, or Total Cholesterol and HDL/LDL ratio only?
4. Cardiac blocks – how to diagnose them before they turn out fatal or serious? The general understanding is, a person whose BP is under control, with or without drugs, and who has a normal Lipid Profile, is not a candidate for blocks. But I’ve met people with normal BP and normal cholesterol readings, falling prey suddenly to illness, and an angiogram reveals major blocks.

I do agree coronary angiogram is not a part of a routine health check up. Annual ECG test is definitely not enough in assessing the cardiac status. I would recommend at least a 2D echocardiogram and stress test as part of a regular check up for anyone over 35 to 40 years. If stress test reveals any changes then further investigation would be needed. The only way to diagnose arterial blockages conclusively is a coronary angiogram and/or CT coronary angiogram, a relatively non-invasive method.

Cholesterol or lipid lowering drugs are quite safe for long term use and their benefits far outweigh the potential risks involved. However it’s important to follow up with your physician and have regular blood tests if you’re on these drugs, to assess their effect on not only cholesterol levels but also on the liver. Statins do not permanently damage the liver, but they do cause transient increase in liver enzymes which are reversible once the drug is stopped.

During a medical check up, we recommend a full lipid profile and not only the cholesterol levels. Reduction of dosage of cholesterol lowering drugs should be done by your doctor at his discretion depending upon the lipid values at any given time. It is true that in a significant percentage of the population heart attacks occur despite the absence of cardiac disease. At the same time people who have severe coronary artery disease do have some symptoms, which they unknowingly attribute to gas or acidity and the condition remains undiagnosed. Hence the need for annual physicals after age 40. If you have any of the major risk factors, you should probably be evaluated at an even earlier age rather than waiting till a problem occurs.

Protect your Heart

medicalquestions — Thu, 04 Dec 2008 08:08:34 +0000

I am a 63-year-old woman suffering from a heart problem for the last 10 years. The report revealed 30% blockages in a major artery. Four years on the stress test came up abnormal. Radiology report revealed calcification of the Aortic Knuckle. My questions are:
1. Do I have increased blockage now? Can it be cleared with medicines & precautions?
2. Any chances of heart deterioration?
3. Is a fresh angiography needed for further investigations?
4. Precautions to be taken. I have been taking T. Ecosprin 75 for many years; avoid all fried or fatty foods. I am taking toned milk and curd, doing meditation, and walk for an hour daily.
You had a coronary angiogram performed in 2002 which revealed 30% block in one of the major arteries of the heart. Subsequently 4 years later in 2006 you have undergone a stress test which is positive with ECG changes in 6 minutes of exercise.
On the basis of the abnormal stress test, there is a distinct possibility that the 30% blockage in the artery has progressed over the last 4 years. You are on medications and the standard precautions would include strict dietary recommendation, regular exercise, weight reduction and lifestyle modification. However, I cannot comment on whether your blockage has increased or not, unless you have a repeat angiography which would give details of the same. The LVEF of 60% in the coronary angiography report in 2002 indicates that your heart function at that point of time was normal. Regarding chances of deterioration of the blockage, if you haven’t taken care in the past 4 years, there is a possibility that the blockage could have been worsened. However, there are various treatment modalities available. I think on the basis of the available reports you should undergo a coronary angiogram and then determine the further course of management based upon its findings.

Missed heart beat

medicalquestions — Mon, 14 Jul 2008 06:00:51 +0000

Question: What causes the heart to miss a beat now and then? Is it dangerous?
If a piece of heart muscle is taken from the body and kept alive in a nutrient solution, it will spontaneously contract at about 40 beats per minute.
There is an area near the top of the heart that is made from a complex network of nerves. This is the natural pacemaker of the heart, and it sends electrical signals to the heart muscle to contract at faster rate of approximately 70 beats a minute. This pacemaker is itself controlled by nerves running to the brain, so that anxiety and exercise can cause the heart to beat faster. Certain chemicals in the blood stream can also act on the pacemaker, and the heart muscle itself, to alter the rate at which the heart contracts. It is therefore a very complex process. The occasional dropped (missed) heart beat is due to a blockage of the nerve signal to the heart muscle, a lack of signal from the pacemaker, chemical disturbances in the body and many other factors. Alcohol, smoking, drugs, caffeine, high blood pressure and several diseases can all cause missed heart beats.
If the dropped beats occur only once every minute or so, there is no cause for concern, as this is a common phenomenon, particularly in older people. If you find that every third or fourth beat is being missed, you should be under regular medical care and probably on medication. Patients with problems within these extremes should discuss the matter further with their doctor. S/he will almost certainly perform an ECG (heart electrical test) and probably order blood tests to exclude any serious disease. The treatment will depend on the result of these tests.
Missed heart beats are not in themselves dangerous, unless they become very frequent.

Blocked arteries

medicalquestions — Wed, 09 Apr 2008 06:00:13 +0000

Question: How the blocked arteries are treated by fixing a small balloon in it ?
When an artery becomes narrowed by fatty deposits, insufficient blood may reach the part of the body beyond the narrowing, particularly during exercise, when more of the oxygen carried by the blood, is required as fuel by the muscles. When this happens, pain occurs in the affected muscle. The area affected can be anywhere in the body, but the most commonly involved ate the heart, head and legs. In past years, the only way to overcome this blockage was an operation to bypass the damaged area of artery, or to clean out the fatty deposits from inside the artery. In the last few years, heart surgeons have devised the technique of balloon angioplasty.
In this procedure, a fine tube is threaded into an artery, and moved along it until the blocked area is reached. The tube has a small balloon on the end of it. The hard tip of the tube is pushed through the obstructing fatty deposits, and then the balloon is gently blown up. This pushes aside the fat inside the artery, compresses it, and when the balloon is deflated, a clear channel is left for the blood to pass.
This delicate procedure saves the time, trauma and expense of a major operation, and is being used more and more where the blockage is not extensive. Large blockages will still need surgery, as sometimes the fat is too hard to be pushed away by the balloon.

Hardening of the arteries

medicalquestions — Wed, 09 Apr 2008 06:00:06 +0000

Question: I have hardening of the arteries. What is this?
If excess levels of cholesterol occur in the bloodstream due to a poor diet or hereditary reasons, it may form deposits on the inside of the arteries. This occurs particularly at points of turbulence where an artery divides or bends.
If a surgeon feels these arteries, they are thicker and firmer than normal, and thus the term ‘hardening of the arteries’. Once it has occurred, medications can be used in mild cases to very slowly remove some of the cholesterol plaques, but in severe cases the only treatment is surgery to remove the deposits of cholesterol or bypass any blockage that may be caused by the deposits. It can be a quite serious disease if arteries supplying vital organs such as the heart and brain become narrowed or blocked.

Sclerosant injections

medicalquestions — Tue, 08 Apr 2008 06:00:59 +0000

Question: I have broken capillaries all over my nose and face, although I am only 32. This is most distressing to me. Can they be treated by sclerosant injections? Is there any other treatment?
Sclerosant injections are suitable for moderate-sized varicose veins in the legs, but are not suitable for the spider-like superficial blood vessels on the face or other parts of the body.
These disfiguring, surface veins are best dealt with by electrocautery or laser treatment. This will usually involve a referral to a plastic surgeon or dermatologist, but a small number of GPs also do this work.
The procedure is simple, and after a local anesthetic injection (or sometimes without, particularly with the laser treatment), a fine needle is placed into the offending capillary, and an electric current is passed through it for a few seconds to destroy the blood vessel. The laser burns the vessel through the skin, without an injection. Both methods leave a small white spot scar at the point of burning.

Difference between Artery and Vein

medicalquestions — Tue, 08 Apr 2008 06:00:55 +0000

Question: What is the difference between an artery and a vein? I am confused about why different blood vessels have different names.
When the heart contracts, it pumps blood out into arteries under considerable pressure. The blood travels along these arteries, which divide into smaller and smaller ones (arterioles), until they finally branch into microscopically thin vessels called capillaries.
Every cell in the body is in direct contact with a capillary, and can obtain oxygen and nutrients from the blood, while giving back waste products.
The blood moves out of capillaries into very small blood vessels called venules, which join up to form veins. The blood travels slowly at low pressure back to the heart through steadily larger veins. Once in the heart, the blood pumped through the lungs to be enriched with oxygen, then returns to the heart again to be pumped out into the body through the arteries again, completing the cycle.
Because the blood in arteries is moving quickly under high pressure, arteries have thick walls containing muscle fibers. Veins are far thinner and softer, blood in them is not under any significant pressure, but because they are weaker, those that do have an increase in pressure, for example in the legs, can dilate and form varicose veins.

Varicose Veins

medicalquestions — Tue, 08 Apr 2008 06:00:25 +0000

Question: What causes varicose veins? My legs look terrible, and I wear slacks all the time as I feel I look terrible in a skirt.
Blood is pumped from your heart out to the hands and feet and every other part of your body. The blood returns to the heart through the veins, but this process does not occur due to the action of the heart. Many people believe that blood is ’sucked’ back from the feet to the heart, but this is not so.
In your legs there are veins superficially just under the skin, and veins deep within the muscles near the bones. When you walk or stand, the deep veins are compressed by the muscular action. This squeezes the blood out of them. These veins are also fitted with one-way valves, so that once the blood is pumped up the vein in your leg, it cannot run back down again. It is the muscular action of the leg muscles on the leg veins that moves blood back to the heart.
The valves also only allow the blood from the superficial veins to go to the deep veins (where the muscular action is more effective) and not the other way around.
If the pressure of blood in the veins builds up excessively due to a restriction of the flow of the venous blood back to the heart, the valves may be damaged and allow blood to pool in the leg veins. Conditions that can restrict venous blood return include pregnancy, obesity and prolonged standing. There is also a significant hereditary tendency.
The dilated veins that result from damaged valves are varicose veins.

Aneurysm in stomach

medicalquestions — Tue, 08 Apr 2008 06:00:04 +0000

Question: I have an aneurysm in my stomach. What is this?
The main artery carrying blood from your heart to the rest of the body is called the aorta. This may be 2 to 3 cm in diameter, and travels down the back of your chest and abdomen just inside the backbone.
If this large artery develops a weak spot from atherosclerosis (hardening of the artery), an aneurysm can develop. The wall of the artery is made of three layers. If the weak spot allows blood to seep into the area between two of these layers, it will gradually separate them and cause a balloon-like swelling on the side the artery.
There are several types of aneurysm. Some are like the traditional round balloon, and sit like small pimples on the side of an artery. Others are long at thin, and appear as a thickening of the artery. Both types ate quite serious, they may burst if they swell to far or you receive a blow to the vital area. As result, doctors usually operate to correct the condition once it is found.