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British Heart Foundation
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Coronary Artery Atherosclerosis, symptoms

Hello, I am new here and appreciating the help from other members. I have a question about Coronary Artery Atherosclerosis.

How does a person know they have Coronary Artery Atherosclerosis? How does a person know they do not have Coronary Artery Atherosclerosis?

I ask because younger brother thought he was perfectly well, had no symptoms, and passed a health check with cholesterol levels and blood pressure raising no alarm bells. Then he died with post-mortem telling us cause is Coronary Artery Atherosclerosis.

Perhaps his health checks were wrong. If so, so be it. That is unanswerable. But if the health checks were correct (cholesterol levels and blood pressure raising no alarm bells) then how does anyone know they have Coronary Artery Atherosclerosis? Do you have to wait for a problem (that could be v. serious or fatal)?

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I am so sorry you lost your brother and it's hard to make sense of how he died when his health checks were clear. Unfortunately there are many instances where apparently very fit people with no symptoms or few symptoms have sudden catastrophic coronary problems. In the months prior to my heart attack my blood pressure was normal range, I was fairly fit and active and also had a normal ECG. I was taking a statin to reduce cholesterol but I had no idea I had coronary heart disease until I had a heart attack. I think you may not get the answers you understandably seek. From what you describe neither your brother nor yourself and those close to him could have known. Sorry I can't give a more logical explanation. Take care.

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Hi I’m sorry to hear about your brother.

I actually had a heart attack leading to a cardiac arrest out cycling . I was very fit, a big cyclists and. Mountain sports generally. Plus gym all since my mid teens. Never smoked, blood pressure fine, cholesterol low. Then impracticality died.

It’s very difficult at the time I had a heart burn feeling leading up to the HA but due to my history my GP insisted I was fine.

An ECG helps but really at rest does not show a problem. At best it requires a stress test I.e. ECG was excercising, eg on treadmill. The only real way to know is invasive and known as angiogram. Basically a tube in your arteries that takes a special dye that shows up under x Ray. They can then see anyblockages.

Though my arteries were prestine so they believed that a plaque (most people in the West will have some on artery wall) may have ruptured and caused a clot.

Who knows you can’t tell. GPs will only refer you for tests if u have risk factors. I even see. A cardiologist privately and last time he refused to give me stress test! Partly because he wants to support my anxiety side of things .

Best of all is to not worry and don’t stress none of us know what’s coming in life. Eg a car crash, cancer, etc etc. Just eat a sensible diet, keep healthy and avoid as much stress as possible

TAke care

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Sorry to hear about your brother, that will clearly make you anxious for your own wellbeing.

I suffered a heart attack whilst cycling 6 years ago and learned some key lessons which I wish I could have had passed on to me before hand. Hopefully they can be of help you.

My achilles heel was that I suffered from high blood pressure and got a clot as as result. With hindsight I can pinpoint the exact day hat I got the clot, racing up a hill with high blood pressure and not warming up. I now know this is an incredibly stupid thing to do.

A two week period elapsed between getting the clot and having the HA, during this time I ignored very clear red stop signs. The clearest was feeling lethargic, I really didn't want to be out cycling, i just wanted to go back home and rest.

The no pain no gain mantra should never be followed and should be seen as dangerous, particularly for older people.

In the 6 years that have elapsed I now know what normal/good feels like for my body and spend much more time listening to it. If my body isn't right I would know and stop exercising immediately and get myself checked out or at least wait until I start feeling normal again.

I now have huge respect for warming up before excercise, at least 20 minutes to get the body going and 45 minutes for heavy excercise. I now never push my body past the point of being comfortable, I now give my older body a lot more respect and just ease off.

Finally, I am much more patient about gaining fitness, the fitness I used to gain in a few weeks in my 20's now takes many months or even years.

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So sorry for your sudden loss.

You can go to your GP and request basic tests such as BP and bloods. If your brother was under 55 then he had so-called Premature Heart Disease which places all first degree relatives at higher risk of CAD. You can proactively ask for an NHS cardiologist's opinion to prevent a heart attack. As others say, a Stress Test (Stress ecg or stress ECHO) as well as possibly a CT Angiogram can be used to find early CAD. (It is not enough to stop at just checking your blood pressure and blood cholesterol, you will need to have a stress test of some sort).

I have premature heart disease in many members of my family, including myself now. However when I first saw a cardiologist who tested with a CT angiogram, it was reported as normal even though there were some early signs of narrowing in one of the vessels. Luckily 3 years later (again on my own request) I had further testing including CT angiogram. Advanced coronary artery disease was found in more than one artery. I now follow a strict whole food plant based diet (wfpb) and ensure that I get exercise as well as keeping a 3 monthly check on my blood pressure, cholesterol and weight.

Unfortunately the NHS is barely coping with actual sufferers of chronic diseases, let alone being able to prevent future chronic diseases so we must take this task into our own hands. Keep pushing the GP and cardiologist if they seem uninterested. I'm glad I did just that because otherwise my fate would be similar to the other 4 family members who have died suddenly of their first and only heart attacks in their 40s and 50s, including my mother.

So in summary, premature heart disease is a red flag to doctors for investigating close relatives for CAD and the recommendations say they must take it seriously.

Good luck with what you decide to do.

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Thank you Springray,

My brother was 62. Should I still press for more tests? I was given the all clear, but the check-up did not include a stress ECG. I asked whether I should have the stress ECG and was told it was unnecessary.

Thanks again (I will look up wfpb diets, sounds yum)

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62 is still very young. Technically prem CAD refers to 55 and under in men and 65 and under in women. You could decide to have a baseline stress test and if problems develop in future (although they won't with WFPB diet), they can compare.

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My first comment is that a resting ECG shows next to nothing if you have clogged arteries. Before my bypass I had four blocked arteries varying between 70% and 85% (my LAD) yet ECGs were normal despite walking much beyond 50 yards was becoming a struggle.

One problem is that they check your BP and cholesterol, and if in range you are fine! I had queried about heart disease when it became apparent that there was an issue on the male side of the family. My grandfather had dropped dead but it is all a bit murky as post-mortems were not done then and my father was but 4! The first symptoms my father had were indigestion (or so he thought) 20 minutes before he died. His younger brother died suddenly a few years later. I feel I was lucky to have developed angina. I see articles about early detection of heart disease but when they hardly seem bothered when you have an appalling family history (my first cardiologist's words) and they do nothing one wonders!

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*I see articles about early detection of heart disease but when they hardly seem bothered when you have an appalling family history (my first cardiologist's words) and they do nothing one wonders!*

I'm actually very glad to read your valuable comment.

In my impression, they/Cardiologists do come up with all sorts of excuses, not to investigate. They call it "reassuring patients by saying it's not Cardiac when patients and their GPs already know and established it's Cardiac" and they seem to think they are being "helpful" by denying the fact as if denying is going to be the best thing they can come up with. They do it because it will be less costly. They have unwritten rules that their NHS managers would take a dislike of certain consultants if they "spend too much" for the sheer luxury of early detection. Consultants know and their hands are tied.

Over different Hubs on this site, there's the common theme that patients spend years being turned away whilst the condition deteriorates further and going around in circles before something serious had occurred. This happened to me.

Of course, if you are about to die unless they operate you, they will be prepared to use the resources, but who wants to be helped when you ended up in that critical situation? NHS should release the financial data as to what diagnostic tests were offered for what sort of symptoms (i.e. signs and symptoms) patients were presented with.

Sometimes, some tests are offered just for the sake of it whilst they may not be the correct tests relevant to the symptoms. I find this would be a waste of resource when patients are given tests just to show they were doing something but if these were not relevant to patients. This is where patients involvement is missing in Cardiology. They TELL you "it's not the heart". Where is the logic in these highly competitive doctors, who battled through the competitive system?

It's their survival that is at stake. That's why they do it and I have seen consultants over decades. Good ones had left NHS or their departments closed down, suddenly their jobs were "restructured". Consultants who cared about the life of patients were treated badly on the NHS. I have seen enough examples. Ones that are good at "meeting targets" without wasteful spending e.g. time, diagnostic tests, working on/paying detailed attention to individual cases. In short, those, who are good at mechanical, factory-style conveyor belt methods will survive well.

Most of them are probably not thinking too well as it won't pay to do so. Old school NHS consultants, who are genuinely dedicated to/care about their own patients and have a genuine interest in their work do not survive.

Patients may die or become disabled by the permanent organ damage but it's hard to prove that NHS cardiology was responsible for the death and the consultants know.

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I’ve onli known I’ve had coronary artery issues because I’ve been checked. Wen I was told I had no heart symptoms at the time but I did before the op.

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I'm so sorry for your loss.

It's not that the tests were wrong; they are only surrogate markers. A combination of markers can give an indication of risk when they are out of range.

That said, Ivor Cummins points out the different levels of risk factors

, and the highest risk comes from insulin-resistance because that is causal, whereas raised cholesterol for instance only indicates a slight increase in risk in comparison. In fact a high triglyceride to HDL ratio also suggests insulin-resistance.

Again, we've been told for so many decades to avoid saturated fat, lower total fat consumption, lower cholesterol levels, and they are all futile. It's excess insulin that is the key problem, caused by high glycaemic loads and by the very actions that are touted as healthy i.e. removing the fat.

Unfortunately, the will to change just isn't there because of the infrastructure and money that is tied up in the status quo, people believing they are doing the best that they can.

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Thank you for your replies. You have been very helpful and reassuring. I am going to read through the many different responses then decide whether to go after more tests (for example, Exercise ECG) or just get on with reducing the risks (diet, exercise, etc.).

Special thanks to:

Concerned, gal4God, autumnsonnet, MichaelJH, Springray, Very_much_alive, pinnelli, and Nathan53

We are very lucky to have this online community!

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