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"A heart scan showed I was a heart attack waiting to happen"

Life-Saving and Life-Changing Stories from Chest CT Scans




Heart Case Studies


*All patient names are fictitious.


**Some stories have been compiled from several case studies and publications.




Men in Larry’s family had heart problems before they were 50 years old. Larry was 52 and confident he had escaped their fate. A HeartLung.AI scan showed his risk of developing serious heart disease was high. With this accurate diagnosis, Larry started on an aggressive treatment plan that can prevent a sudden heart attack.




Larry* thought he had dodged his family history of premature coronary artery disease. Larry, a white male, felt great at age 52. He didn’t smoke or have diabetes. He ate “a good diet” and had a regular exercise routine. Maybe earlier generations of the men in his family had developed early heart problems before they were 50 years old, but he seemed to be doing fine.(2)


Coronary artery disease (CAD) is the most common type of heart disease in the United States.1 It happens when the arteries (blood vessels) that supply blood and oxygen to the heart become clogged with plaque, which are deposits of cholesterol, calcium, and waste substances. The plaque builds up in the walls of the arteries, causing them to narrow. This process is called atherosclerosis and can eventually completely block the blood flow.1 The result is a heart attack.(3)


At his next annual physical. Larry’s primary care physician took a hard look at Larry’s health.


  • Blood pressure 139/85: The American Heart Association lists 120 or less and 80 or less as normal. Elevated blood pressure is 120-129 and 80 or less. High blood pressure of 130-139 and 80-89 is considered Hypertension Stage 1. Larry is in this and is very close to Hypertension Stage 2 of 140 or higher or 90 or higher.(4)

  • Cholesterol HDL 60: For men aged 20 and older, HDL (the “good” cholesterol) should be 40 or higher.(5,6) With a normal range of 45-70, Larry had an appropriate HDL level.

  • Cholesterol LDL 135: For men aged 20 and older, LDL (the “bad” cholesterol) should be less than 100.5,6 With a level of 135, Larry is in the “borderline high” category, 130-159.(6)


Larry’s physician did a traditional calculation, called the Pooled Cohort Equation, to estimate the likelihood of Larry developing atherosclerotic cardiovascular disease (ASCVD) within the next 10 years. The result of 4.7% put Larry in a low-risk category.(2) Larry was pleased.


However, the blood pressure and LDL cholesterol findings, combined with Larry’s family history, made the physician uncomfortable. The physician decided to send Larry for a Coronary Artery Calcium (CAC) scan.


A CAC is a low-dose CT scan that uses special X-ray technology to take thin cross-sectional images of the heart, called slices. When the slices are combined, they create a 3-D copy of the heart to measure the plaque deposits in the blood vessels that bring oxygen to the heart.(6)




Larry and his physician were shocked to see that Larry’s CAC score was 325. He was now in the 95th percentile for his age—only 5 people out of 100 would have a higher CAC score. Now his 10-year risk of developing ASCVD climbed to 12.8%.(2) (Had the CAC score been 0, Larry’s risk would have only been 2.8%, lower than the traditional calculation method).(2)


With this new and accurate information, his physician could now plan personalized care for Larry. Using the 2018 Coronary Artery Calcium Guidelines(8) that are endorsed by The American College of Cardiologists and The American Heart Association, Larry’s physician could provide aggressive treatment that would help Larry have the best possible outcomes and prevent an early heart attack.


Here is Larry’s treatment plan:


  • Eat a healthy “Mediterranean” diet with vegetables, fruit, nuts, beans, whole grains, fish, and extra-virgin olive oil. Eggs and cheese are eaten in moderation, and red meat is eaten rarely.

  • Increase exercise. The American Heart Association recommends a minimum of 150 minutes of moderately intense exercise per week10 to lower LDL cholesterol. Larry was already active, so he could begin to increase his exercise intensity right away.

  • Because of his high CAC score and borderline high blood pressure, Larry started on a medication to prevent his blood pressure from going higher.(2)

  • To lower cholesterol, his physician prescribed a statin. Statins also reduce the risk of heart disease and stroke.(2)

  • Larry also started to take a small dose of aspirin every day, to prevent clots that could cause a heart attack or stroke.(2)


Without having the CAC scan and knowing his CAC score, Larry’s physician would have continued to monitor Larry without any preventive treatment. Thanks to technology and the ability to measure the calcium in Larry’s arteries, now he can avoid a sudden heart attack.




REFERENCES

  1. Coronary Artery Disease (CAD), Reviewed July 21, 2021. Centers for Disease Control and Prevention, Atlanta, GA. https://www.cdc.gov/heartdisease/coronary_ad.htm (Accessed 2 October 2021)

  2. Blaha, M. Coronary Artery Calcium: Finally Endorsed in Major Guidelines. Houston Methodist DeBakey Grand Rounds Conference. October 1, 2020. https://www.youtube.com/watch?v=G8Wabh8OIUM (Accessed 27 September 2021)

  3. Coronary artery disease. Mayo Clinic, Rochester, MN. https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613 (Accessed 2 October 2021)

  4. Understanding Blood Pressure Readings. American Heart Association, Dallas, TX. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings (Accessed 2 October 2021)

  5. Cholesterol Levels: What You Need to Know. Medline Plus, U.S. National Library of Medicine. https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html (Accessed 2 October 2021)

  6. Cholesterol Numbers: What Do They Mean? Cleveland Clinic, Cleveland, OH. https://my.clevelandclinic.org/health/articles/11920-cholesterol-numbers-what-do-they-mean (Accessed 2 October 2021)

  7. Heart scan (coronary calcium score) Mayo Clinic, Rochester, MN. https://www.mayoclinic.org/tests-procedures/heart-scan/about/pac-20384686?p=1 (Accessed 9 September 2021)

  8. Taron et al. Coronary Artery Calcium Score–Directed Primary Prevention With Statins on the Basis of the 2018 American College of Cardiology/American Heart Association/Multisociety Cholesterol Guidelines. Originally published 22 Dec 2020 Journal of the American Heart Association. 2021;10:e018342 https://doi.org/10.1161/JAHA.120.018342 (Accessed 9 September 2021)

  9. Gunners, C. Mediterranean Diet 101: A Meal Plan and Beginner’s Guide. September 17, 2021. Healthline/PubMed. https://www.healthline.com/nutrition/mediterranean-diet-meal-plan (Accessed 3 October 2021)

  10. Prevention and Treatment of High Cholesterol (Hyperlipidemia) American Heart Association, Dallas, TX. https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia

(Accessed 3 October 2021)

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