We do our best to avoid the often devastating events caused by cardiovascular diseases. That’s because they are the number one killer of Americans, accounting for about 45% of adult deaths.
More than one million of us will suffer a heart attack this year. Of those, 30% won’t survive the acute episode, and 10% more will die during the next year. About 500,000 will suffer a stroke. More than a third will be left with significant disability and another third will die within one year.
Most often, heart attack and stroke are due to blockages of arteries that supply blood to the heart and brain. We have powerful tools to prevent plaque build-up, but we have to know when to use them.
And if we arrive at the problem too late, excellent surgical and non-surgical methods to remove or bypass such blockages have been developed. The key is to perform them before the damage is done.
Finding people with impending heart attack or stroke is not simple. One quarter of heart attacks are silent and another quarter occur without prior warning. Fully 80% of strokes occur without warning symptoms. And both events occur often in persons with few or no known risk factors. So the traditional approaches of using risk factors to guess who has plaque and applying diagnostic tests only in those with symptoms often fails to anticipate heart attack and stroke.
Normal caliber arteries are essential for uninterrupted delivery of blood to the brain. Narrowing by plaque accumulation can impair brain function and, if severe, results in stroke. Artery expansion, as in the case of aneurysms or other malformations, can lead to rupture and brain hemorrhage. Brain artery problems are often congenital. Many of these problems have non-invasive remedies. To detect them, the Modern Physical periodically images your brain’s arteries using magnetic resonance angiography, a non-invasive, radiation-free procedure.
The carotid arteries are large vessels on both sides of the neck that carry most of the brain’s blood supply. Plaque in these arteries accounts for about ¾ of all strokes. These arteries may become critically narrowed by plaque, or plaque may be dislodged from their walls, traveling downstream to plug a smaller artery. Because these blood vessels are close to the surface, their anatomy can be determined with ultrasound imaging, and a special technique permits measurement of the rate of blood flow through them. Imaging the carotid arteries periodically is an important part of the Modern Physical’s stroke prevention, because critical narrowing can be detected and repaired, greatly reducing the risk of future stroke.
These form a network of relatively small arteries on the heart’s surface that provides blood, nutrients and oxygen to the heart muscle. When one of these arteries is blocked by plaque accumulation or blood clot, part of the muscle often dies, a “heart attack.” About 40% of Americans will develop enough plaque in these arteries to cause major health problems. The conventional approach to atherosclerosis in the heart is to guess how much plaque is present based upon the presence or absence of a few coronary risk factors, a calculation that is often inaccurate. The Modern Physical aggressively watches the actual state of the heart’s arteries by coronary artery scanning, providing a very sensitive look at the vessels. Individuals who are accumulating plaque undergo rigorous control of plaque-promoting conditions and undergo frequent assessment of the functional state of the arteries with stress imaging.
Proper chamber structure and valve function are required for optimal heart performance. Congenital malformation or deterioration can impede blood circulation through the heart and lead to serious illness. Heart imaging via echocardiography can check for normal structure and function of the heart. The Modern Physical periodically checks to see that the heart muscle is structurally intact and that valves are working properly.
The aorta is the body’s largest artery, distributing blood from the heart to major organs. Plaque buildup in the aorta is common, but because of its large caliber, blood delivery is seldom impeded. But atherosclerosis can weaken the wall of the aorta and this process, together with congenital abnormalities, account for most aortic aneurysms. Those aneurysms, outpouchings of the aorta, are structurally weak and can rupture, almost always leading to rapid death. Aneurysms can develop in the chest or abdomen. Fortunately, they arise slowly. Chest and abdominal imaging procedures of the Modern Physical regularly assess aortic caliber and identify aneurysms in the early stages, before catastrophe occurs.
Relatively large arteries supply blood to kidneys and limbs. They, too, are vulnerable to plaque accumulation. Using non-invasive imaging, blood tests of organ function, and physical assessment, the Modern Physical monitors the status of these important blood vessels.
A variety of actions and conditions increase the likelihood of blood vessel problems. These include a family history of heart disease, cigarette smoking, obesity, high blood pressure and emotional stress. Biochemical abnormalities, such as diabetes, excess homocysteine, inflammation, and abnormalities of cholesterol metabolism can contribute to atherosclerosis. Particular genomic abnormalities have been implicated in arterial disease, and a deeper understanding of the impact of genetic interactions is forthcoming. The Modern Physical carefully monitors all of these potential risks, many twice yearly. Interventions to reduce risk are often suggested, especially in individuals who are known to carry plaque and in those with multiple risks.
Explore the intricacies of the Modern Physical’s detection and prediction methods in the links below.