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A myocardial bridge is when a portion of heart muscle overlaps the coronary artery that normally sits on the surface of the heart. It is rare but can cause a narrowing of the artery. The underlying principles remain the same- unless the narrowing is greater than 70% it will not likely show up on a stress test. It is also unlikely to cause exertional symptoms. Myocardial bridges are not likely to cause plaque rupture or heart attacks but can cause angina. However, the point is that stress tests are good for finding out if chest pain is angina due to arterial obstruction but are not good for finding out if you are at high heart attack risk from plaque.

While stents are generally recommended only when the degree of blockage in an artery exceeds 70%, most heart attacks happen in arteries that are less than 50% narrowed. In many cases, heart attacks may even happen in arteries with no significant narrowing at all. The culprit is rupture of the surface of the plaque which causes a clot to form at the site of the plaque rupture. The vast majority of the time the clot that forms is either too small to completely block the artery or it dissolves before any significant damage has occurred. Heart attacks very likely occur in only a very small fraction of the plaque ruptures. While narrowing of the artery can occur again after placing a stent, the goal of the stent is to restore a normal diameter to the artery. Therefore, an artery that has been stented should not be much more susceptible to being blocked by a small clot than if there had not been a stent there in the first place. The bigger issue is that studies have shown that stents are effective at reducing angina symptoms but are much less effective at preventing heart attacks because the stent treats only a very small segment of one artery. Since plaque is usually present throughout the coronary arteries, there is still a risk of plaque rupture causing a heart attack in the remaining segments of the arteries other than where the stent is at. Medical therapy with lifestyle changes, statins, aspirin, etc., turns out to be more effective than stents at preventing attacks. If the main use of a stent is to treat angina and the angina is well controlled with medication there is less need for the stent.

Hi Sangey, While I can understand your concern - it is not appropriate or ethical for us to comment on how your care should proceed without ever having evaluated you personally. You should continue seeking care from your physician or emergency room and we are happy to discuss scheduling an appointment for you at our center in addition to your current treatment so that we can better discuss your treatment plan.

@@PrincetonLongevity it can be heart related iam 29 years old

@@sangeynguedang6894 We simply have no way of knowing without physically examining you.

@@PrincetonLongevity Thank u for your reply sir.15 days ago I had done my test

I stay in a small town so here no cardiology available.i have to go far for check up

Coronary calcium scores are an indication of coronary artery disease. Sometimes, further testing is required to better understand the degree of disease and help decide the best treatment strategies. Most people who have cardiovascular disease have no symptoms. That's why Coronary Calcium Scoring and Cardiac CT Angiography are important screening tools. They help us to find disease BEFORE symptoms when treatment is easier and more effective. By the time there are symptoms, there is most likely already a severe blockage, plaque rupture or heart attack. To learn more about why this happens - please watch our video on stress testing at ruclips.net/video/jq_H3HIqU6c/видео.html.

Discovering atherosclerosis of the aorta is common depending on age and other risk factors. When found, the chances of also having atherosclerosis and plaque in the heart arteries is higher. A coronary calcium score help us to assess that risk much better.

Thank you so much. I had my coronary calcium scan done today. I got the report and score is 200. All the arteries have score of zero except Left Anterior Descending. How bad is this? What steps I can take to diagnose further. Please advice. The report also mentioned mild atherosclerosis calcification of the arota. Thanks

@@parulshah4703 Hi Again! We cannot give medical advice via RUclips but in general, Calcium scores are used to detect coronary plaque and help assess risk of heart attack. Depending on age, gender, and other risk factors for disease, further evaluation may be necessary to identify ways to slow the process of coronary artery disease and thus more effectively manage heart health.

@@parulshah4703 reduce ldl c to 55mg and add aspirin 81mg daily

Most likely. A man at 40 with a calcium score of 150 is over the 90th percentile for people his age and is considered very high risk. For a man at 80 with a score of 150, 75% or more of men his age will have a higher score and is considered lower risk that most at his age. Both patients have plaque and are at risk and we would treat the 40 year old aggressively to reduce his future risk of heart attack. I have uploaded the chart showing average scores for age on our website at princetonlongevitycenter.com/cacs-in-asymptomatic-patients-graph/ for your review.

Excellent question. We know that things such as diet and exercise can help slow the process of plaque formation and calcification. At PLC we strongly believe that this is critical, which is why our exams include a visit with an exercise physiologist and dietician/nutritionist. In many cases, medications and further medical evaluations are needed to fully understand and properly follow the development of coronary disease.

First of all, excellent handle Mr. Gladiator! In cardiology, know very little about the actual process of plaque destabilization and plaque rupture (i.e.. Why does it happen and when). We do know that this is often the inciting event for a heart attack, but in medicine, we are not necessarily good at predicting plaque rupture. Therefore, it is very important to have a thorough and complete cardiovascular assessment and to fully know your individualized risk of heart attack.

I had 3 CAC Scans. In 7/2017 it was 107 so I started taking a statin. In 8/2019 it went up 85% to 193 so I stopped the statin and just took K2, D3, magnesium, aged garlic. (I also was limping with the statin - and the limp disappeared after stopping it.) On 7/2021 my CAC score was 164. It had decreased. I'm a 72 year old woman who has been 100% vegetarian for 49 years. My husband with same diet has zero plaque. I'm hoping to slowly remove the plaque. LAD artery went from 99 to 75. LCX artery went from 94 to 89. Maybe in 10 years it will be gone. I never had any heart pain or any body pain except leg muscle while taking a statin. I've never been to the ER, hospital, or had surgery.

@@PrincetonLongevity RIGHT You ONLY study Big Pharm meds that are the third leading cause of death.. GOOD Job Murderesi

Hi Iraklis - unfortunately it would be inaccurate and unethical for us to comment directly on your care without having examined and interviewed you as a patient. A Cardiac CT Angiography is a heart scan that uses a small amount of contrast dye to help highlight the arteries. This enables us to see both calcified and non-calcified plaque and we can, therefore, see stenosis (narrowing or blockage) of an artery where a calcium scoring you can not (calcium scoring is strictly used as a screening test for heart attack risk assessment). Cardiac CT Angiography is very low risk test and highly accurate when performed and interpreted by physicians and technicians who have specific expertise in this imaging. You should discuss with your physician if this advanced diagnostic cardiac scan could assist with determining next steps in your care.

We have known for quite some time now that there is a link between higher cholesterol levels and the development of coronary disease. There is a growing body of scientific evidence that looks at people with elevated levels of cholesterol and no coronary artery disease. This is one such study from 11/2020: www.jacc.org/doi/full/10.1016/j.jacc.2020.07.059?download=true Due to the relationship between elevated LDL cholesterol and the later development of coronary disease, high LDL levels are often treated even without disease present. There are now options available for people who are “statin intolerant” which can include a cholesterol lowering medication of the class PCSK-9 inhibitors. It’s best to speak to your doctor whether these may be right for you.

@@PrincetonLongevity Thank you very much for the reply. My mom and dad, aunts and uncles living in the 80s and 90s with no known heart attacks or strokes. I also watch the video from Dr David A Fein. He said the cholesterol level is dangerous if it is making plaques. Some people have normal or low cholesterol level, but have a lot of plaques, others have high cholesterol levels and no plaques. I'm really confused. Having discussions with my primary doctor and 2 cardiologists, they insisted me taking statins to lower my cholesterol levels. My ultimate question is "Can cholesterol ALONE cause the making of plaques" or inflammation/insulin... are the drivers and then cholesterol accumulation. I'm in Seattle area. Do you have any recommendation for a doctor that can take a comprehensive evaluation of my own situation instead of relying on data for general population? You can send my a private message if you like. Thank you!

@@taylorcollins2080 It's not a one-size-fits-all answer unfortunately. Without a thorough medical evaluation it is impossible and unethical to give the guidance you are looking for. Our exams do offer a comprehensive evaluation in a thorough 7-8 hour day using the latest technology and research to provide individualized plans for optimal health. This is the type of exam you're looking for but these exams are not routinely available. The PLC Exam and centers have a very unique offering and we see clients from all over the country and world for this reason. Our four offices are on the east coast (NYC, NJ, CT and DC) and we, unfortunately, are not aware of another program near Seattle with an evaluation like ours.

@@PrincetonLongevity Thank you very much. I hope one day I can have a visit to one of your centers.

Coronary plaque forms in the vessel wall. It tends to occur in a layer called the “endothelium” which is comprised of the first few cells along the inside of the vessel. Once plaque develops, it can involve other layers such as the muscular layer after the endothelium. Additionally, there are a few characteristics of the plaque that we look for in cardiology such as calcified and non-calcified amongst other characteristics. By and large however, this process is a disease of the vessel wall itself.

I was thinking of a false positive from a CAC scan, if the test picks up calcium that can be on outside of arteries..I was told this.. and that I don't fit the profile...confused in MI

@@repiv275 Calcium scores are very reliable. Sometimes after a calcium score is performed, we elect to do a CT angiogram. With this type of test, we can determine the amount of non-calcified plaque present. However, non-calcified plaque is only seen on a CT angiogram utilizing contrast enhancement.

Giving a false score?

It will - calcifications anywhere glow bright white on a CT Scan.

@@PrincetonLongevity how do you determine if plaque is on the outside? Is it up to the radiologist who reads CAC scan?

Calcium is found all over the body; in cells, in bones, and circulating in the blood. Calcium is essential for many functions in both cellular activity, muscular function, and bone health. The type of calcium that we see in coronary arteries on a calcium score is related to cholesterol plaquing and coronary artery disease. Over the last 30 years, PLC has been very active in the research of this technology and our doctors regularly contribute to the screening guidelines from the America College of Cardiology.

Hi Moe - it would be both inaccurate and unethical for us to comment on your specific care. A calcium score and stress tests are often used together and one does not exclude the other. A calcium score is used as a tool to establish risk of heart disease/heart attack and is better at doing so than a stress test. In many cases a person who has had a heart attack would pass a stress test even the day before. A stress test is generally used for visualizing occlusion of an artery in determining who might need corrective therapeutics or surgery and is not used for risk stratification.

@@PrincetonLongevity thanks a lot you guys are great

@@moet4519 - Regular stress test typically only detect inclusion (blockage) of 50% and greater. Most cardiac events happen with less than 50% blockage. ie, stress test is crap. Get CAC test. My score is 123.

There are many ways to evaluate for coronary artery disease. The treadmill stress test that you described carries a sensitivity and specificity of about 85% and 87% respectively for obstructive coronary disease (ie. stenosis that is > or equal to about 70%). The coronary calcium score is different in that it is a terrific screening tool to help risk stratify patients at intermediate risk for coronary disease. There is much evidence to show that coronary calcium scoring helps re-define 10-year atherosclerotic cardiovascular disease (ASCVD) risk as noted in the link below. Furthermore, in many clinical scenarios a coronary calcium score is used as an adjunct to stress testing or CT angiography. www.jacc.org/doi/full/10.1016/j.jacc.2018.05.027?_ga=2.169042023.776165679.1607028058-1315351777.1602787695

You want the CAC test because it is a baseline of any calcium in you arteries. This is extremely important for those with risk factors. Your doctor does not understand this. He should go back to his med school and get his money back because he got robbed. Additionally, follow up scan will show you how poorly most doctors can not stop progression of heart disease. Moreover they blame the patients for poor outcomes. Because they can not imagine their professors were wrong. Lastly stress test detect blockages of 50% or greater typically. In other words, you were treated as a lab rat to generate income for the testing lab or hospital.

@@carnivorechronicles Thank you both for your comments. I will check with another doctor. Appreciate the time you both took to reply. Screen shot taken for my next doctor.

He’s missing the point! I had normal cholesterol levels, negative nuclear stress test. Great right? Went and got a CAC scan…..horrible score of 738!

@@gibsonguitarplayer - My score is 123, April 2019. And I just got another test last Wednesday and awaiting results. Sorry to hear about you score. Now that you know you can institute secondary prevention. What are you doing to halt you progression?

Hi Dorishel - we don't have a next presentation scheduled but will notify you when that is available. We are also working on more HIIT workouts and you can also reference the Football Fitness Challenges in the meanwhile which also are HIIT workouts! That playlist can be found at ruclips.net/p/PLIdUz_0vQqtjrKdQNCJk4NMrWY5JURrhL.

Princeton Longevity Center Thank you

Hi Randy - Thank you for your feedback. It might not have been clear but this webinar was produced for Heart Health Month and the focus was on a cardio workout - not one specific for weight loss. Per Dr. Harry Pino, Manager of Exercise Physiology at PLC: Research is showing that resistance training will help not only lose weight but preserve muscle. The focus of the video was to incorporate a little bit of both. This was meant to do at home with no equipment, however body weight is definitely easier. I do agree with the observation made. You can add resistance by using kettle bells or dumbbells. We hope this helps!

That is not what we are saying. What we are saying is a stress test is a poor predictor of heart attack RISK. In general a stress test can only show a blockage of 70% or more. Since most heart attacks happen in a vessel with 50% blockage or less (due to plaque rupture... not gradual narrowing), it is likely that most who have a heart attack would pass a stress test even the day before.

@@PrincetonLongevity i know i was kidding my nervous system is bad i am trying to add good stress which can make me get less anxious and recover

Hi Usman! Unfortunately it is not accurate or ethical to speculate on chest pain without examining you as a patient and running tests. Chest pain should always be thoroughly evaluated by a physician. If you have not already sought the help of a doctor - please do so immediately.

@@PrincetonLongevity I had recently done ETT and ECHO test they r all normal even I had done other test like TROPT lipiprofile by many times doctor said it seems like anxiety or spondilites pain or Gastro ...let c

@@UsmanAli-si7rz Without ever seeing you as a patient for a full medical history and hands-on examination it is inaccurate and unethical to provide medical advice. Please speak to your physician or seek the assistance of another physician for a second opinion.

@@PrincetonLongevity thank you very much for such a good advise Even this is my second opinion first doctor told me for Angiography but 1.5 or more old chest pain can be a heart related?

So Usman how u feel now, did u find out what was z prob... I guess I have z same symptoms and tomorrow have stress test

Hi Kuch- thank you for your question. Stress tests generally require a significant blockage causing reduced blood flow to read as positive. Our point is not to say that this test can assess your minimum blood flow - our point is to say that stress tests are a poor way to predict heart attack RISK. They are really for determining who might need invasive cardiac intervention to fix a problem. Cardiac CT is the better way to evaluate the heart for risk of heart attack so that early and less invasive intervention can be used to prevent a future heart attack. We're happy to answer your questions about the testing at PLC or our expertise in Preventive and Executive Medicine. Please feel free to call us at (888) 8000-PLC or email your questions to info@theplc.net. We look forward to hearing from you!

Hi Uttam - thank you for your question. Without knowing your full medical history and having examined you as a patient - it would be both inaccurate and unethical to provide medical advice regarding your specific situation. We're happy to answer your questions about the testing at PLC or our expertise in Preventive and Executive Medicine. Please feel free to call us at (888) 8000-PLC or email your questions to info@theplc.net. We look forward to hearing from you!

Hi Adam - thank you for bringing that information (or lack thereof) to our attention. We are talking about a Coronary Artery Scan or Coronary Calcium Scoring done with high-definition CT. This is the best non-invasive test to identify your risk of heart attack. Please let us know if we can answer anything else!

Princeton Longevity Center - Thank you for the details. I am sitting in the cardiologist now waiting to be called for my first "stress test." I have not had chest pain, just a variable heart rate i.e. 30-50 bpm increase from sitting to standing. Guess I see in a few hours if it was a waste of time or not. :)

What does two day Lexi scan mean

​@@mitsured so what happened?

@trent o nothing was found. My doc put me on a low dose of atenolol. This has helped with my heart rate.