Lecture on Cardiovascular Health and Plaque Management

Introduction

• Plaques in Arteries:
  • Two main dangers: narrowing arteries (angina) and cracking (inflammation).
  • Cracked plaques can cause heart attacks.
  • Importance of an anti-inflammatory lifestyle and diet to prevent plaque cracking.

Plaque Stabilization

• Aim to stabilize plaques, prevent growth, and avoid cracking.
• Narrow arteries with over 75% blockage reduce blood flow.
• Symptoms of reduced blood flow: chest pain, shortness of breath, palpitations, or asymptomatic.

Diagnostic Approaches

• Calcium Scoring:
  • Detects calcification in artery walls to assess coronary disease risk.
• Stress Tests:
  • Used to identify blood supply issues by evaluating EKG changes and blood supply to heart muscle.
• Angiography:
  • Invasive test using dye to visualize artery blockages, but doesn’t indicate flow limitations.
• CT Angiography:
  • Non-invasive, provides visual of arteries and blockages, but can overestimate due to calcium shadows.

Advanced Diagnostic Tool: FFR

• Fractional Flow Reserve (FFR):
  • Measures pressure differences across a blockage to assess flow limitation.
  • Invasive FFR performed in cath lab with a pressure wire.
  • Non-invasive options include CT-FFR, analyzed by AI, providing insight on functional severity of blockages.

Importance of Functional Testing

• Functional tests (FFR) essential before interventions like stenting or bypass surgery.
• Ensure interventions are only for lesions that limit blood flow.
• Many patients undergo surgery without need due to lack of functional testing.

Treatment Considerations

• Not all blockages require stenting; assess if they are flow-limiting.
• Overreliance on stenting and surgery without functional evidence can lead to unnecessary risks.
  • Risks include stent thrombosis and restenosis.

Systemic Disease Management

• Coronary artery disease is systemic and requires systemic treatment.
• Lifestyle modifications (diet, stress management, sleep) crucial to stabilize plaques and prevent progression.
• Focus on reducing inflammation, a major driver of plaque instability.

Inflammation and Cardiovascular Health

• Sources of Inflammation:
  • Gut health, hormonal imbalances, and toxins.
• Lifestyle Influences:
  • Diet, sleep, stress management all critical in managing inflammation.
• Epigenetics:
  • Lifestyle affects gene expression related to disease risk.

Conclusion

• Effective management of coronary artery disease involves a combination of diagnostic accuracy and lifestyle interventions.
• The goal is to stabilize plaques, prevent growth, and avoid unnecessary invasive procedures.
• Emphasis on personalized medicine and prevention strategies.