CV health evaluation

[mccoy]

Hi everyone,

it's time that I have an adequate screening of my cardio-vascular health.I'm already monitoring blood sugar, blood pressure and lipids, but I'm missing exams to the system. So I mean direct exams such as electrocardiogram and.... what next? Last one was about 15 years ago. Now I am 58 years of age.

Can you guys suggest a basic yet effective set of tests-exams to evaluate the fitness of my hearth and circulatory system? what are you doing personally?

Edited April 1, 2019 by mccoy

[mikeccolella]

Well you could do a exercise treadmill test, but I can tell you when my aortic valve was severely stenosed and needed surgery 6months later I passed an exercise stress test, same with an electrocardiograph. The test that caught it was an echocardiogram. I was feeling awful and they thought I was crazy!  Another easy test is heart rate recovery test which you can do yourself. You go all out and get your heart rate up to say 90% and maintain it for a minute or so and then stand but stop all activity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466608/

another one is the heart catherization which is totally reliable but poses dangers and is not recommended unless you have angina or other signs of advanced atherosclerosis. Also angiography which is safe but less reliable. They use a dye put into your blood and then take a picture o& your heart.

personally I wouldn’t do any of them except the heart rate recovery test. I’m not a big fan of screening unless there are serious symptoms. Although people it seems often have heart attacks without ever having symptoms or so they claim. Denial is HUGE, HUGE HUGE, no question and many people have them but brush them off. If you are conscientious and objective I think you can go a long way in getting a handle on your heart health. Doctors pestered me all my life with tests and created unnecessary anxiety about my heart valve which was damaged when I was 3 years old. Turns out the only test I ever needed was at 63 and I knew My valve was bad before I had the test. Didn’t need no doctor to tell me. I did need open heart surgey

[mccoy]

Thanks Mike, I'll have to do the recovery test, I presume 90% is related to the max safe heart rate durign exercise which we can figure out in online calculators.

I'll have to find a good heart rate measuring device though, the cheap one I bought, with toracic belt, ceased functioning. I prefer the one which sends signals to a wrist watch, so that I can see the variations real time.

Of course that doesn't ruel out the medical screenings you suggested.

[Ron Put]

I assume you already did your tests. By 58, you should be doing a blood panel at least every few years, so you can spot changes. And let's not forget colonoscopies and prostate exams, and blood pressure check ups.

A periodic stress test is not a bad idea once one hits 50, echocardiogram is usually done then. A chest x-ray is usually part of an annual exam, and a decent radiologist should be able to spot an aortic valve issue (those are relatively rare).

A 23andme test may be of some value as well, as it identifies some general predispositions to keep an eye on. It's even more fun when you feed the raw data through promethese. If you want a whole genome test, I am a fan of Nebula Genomics (nebula.org) -- for now it doesn't offer all that much, but it holds promise for the future.

Hope all is well with the test.

Edited June 2, 2019 by Ron Put

[mccoy]

Thanks Ron, I'll update the forum when I'll be able to have my echocardiogram done.  The old ticker is the 1st one I'm going to check, hopefully soon. My previous simple ECG was 15 years ago or longer. I agree upon blood panels, probably one or twice a year is an optimal frequency. 

[mikeccolella]

I passed a stress test and a few weeks later an echocardiogram revealed severe aortic stenosis caused by childhood rheumatic fever. I ended up getting open heart surgery. 

[mccoy]

At last I was able to go the cardiologist. He did a pretty exhaustive visit, 40 minutes long, including an electrocardiogram and an echocardiogram, which was the advised preventive exam in mike's opinion,  and that was also confirmed by a physician I asked to.

The results were very good. During the visit my heatbeat was unusually low, (52 bpm) as well as the blood pressure (110/70),  i can only hypothesize why, subject of another thread I'm going to open.

I'm not finished though. I asked to the doctor why after meals I often observe higher bpms than the baseline, let's say, from 60 baseline to 80 and more after meals. He advised a stress test and a 24 hours holter monitoring. If such exams, especially the stress tests, will be negative, then he would exclude a coronaropathy or CAD. He told that obstructions in the coronaries are invisible to the echocardiogram, although he did not observe any indirect suggestions of such a condition. So the progression he suggested:

• Stress test (+ eventual holter monitoring). If negative, end .
• Coronography (CAT with contrast, if not the invasive one by catheter).

 

Edited June 13, 2019 by mccoy

[Saul]

On 6/13/2019 at 12:41 PM, mikeccolella said:

I passed a stress test and a few weeks later an echocardiogram revealed severe aortic stenosis caused by childhood rheumatic fever. I ended up getting open heart surgery. 

Hi Mike!

Sorry that you had the problem -- but it's good that you had the echocardiogram.  Hopefully the operation went well?

  --  Saul  

[Gordo]

On 6/13/2019 at 3:58 PM, mccoy said:

I asked to the doctor why after meals I often observe higher bpms than the baseline, let's say, from 60 baseline to 80 and more after meals.

I think your doc's advice is a bit ignorant (absent other symptoms you failed to disclose).  Higher bpms after meals is fairly typical.  Here's a discussion thread of a bunch of people talking about this in a fitbit forum:

https://community.fitbit.com/t5/Eat-Well/HR-users-Increased-heart-rate-after-eating/td-p/927029

 

Edited June 17, 2019 by Gordo

[mccoy]

Thanks Gordo, I've read all that thread and some people seem to have a really drastic spike in HR even after moderate meals.

The cardiologist I saw works in intense care at the hospital, so maybe he's more focused on near deadly situations or situation with heart issues. At the beginning, he didn't even understand why I was seeing him and it took a little time before he fully realized it was a preventional check with no serious symptoms. The visit appeared to be pretty complete and careful though.

Postprandial tachycardia: it's a bummer at times, and that's one reason why I could never do intermittent fasting with one large meal per day. As far as I've observed, it's a function of quantity and quality of food, also gas bloating may be a cause. I found this concise explanation in one site which rings true to me:

Quote

While these signals originate in the brain, pressure in the abdomen caused by large meals, gas or bloating can cause the vagus nerve to be stimulated. This harmless stimulation can cause a temporary disruption of the heartbeat.

So this check at the cardiologist is going to be followed by two actions on my side:

1. ECG under stress. Just to definitely rule out coronary occlusions and being able to say my ticker is good for a while, or viceversa, to have a coronography done.
2. HR monitor: I'll have to get another one, after the cheap one I bought ceased to work a short while after the purchase. I might decide to design my meals in such a way to lower postprandial tachycardia.

[Gordo]

You should get a heart rate variability monitor - they are pretty cheap and can actually tell you a Lot about your health and rate of aging (as well as tracking heart rate). See the thread here on that... 

[Sibiriak]

Histamine induces postprandial tachycardia through a direct effect on cardiac H₂-receptors in pythons

Nini Skovgaard et al

Mar 2009

https://doi.org/10.1152/ajpregu.90466.2008

 

Quote

[...]In humans, the postprandial dilation of the splanchnic vascular bed is attended by increased cardiac output accomplished through a rise in both heart rate and stroke volume, so that systemic blood pressure is maintained (11, 20, 43). Little is known, however, about the regulation of this response. In addition to the autonomic nervous systems (8, 15), the postprandial cardiovascular response is probably governed by the direct action of hormones such as endocrine regulatory peptides released from the gastrointestinal organs (3, 7, 12). In fact, patients with transplanted and fully denervated hearts exhibit a pronounced postprandial rise in cardiac output (19, 44, 45), suggesting that the cardiac stimulation is not reflex in nature, but, at least partially, mediated by humoral factor(s).

Humans and the common mammalian model species, such as mice and rats, are adapted to consuming small meals at frequent intervals. The magnitude of the digestive responses is, therefore, low, and the underlying regulatory processes may be difficult to identify. Pythons, in contrast, ingest large whole preys at infrequent intervals with large changes in digestive performance, making these snakes an interesting and suitable model species for investigating cardiovascular and gastrointestinal regulatory physiology associated with digestion (33, 46).

Thus, in pythons, digestion causes a 10-fold rise in metabolism that can be sustained for up to 2 wk attended by a marked and rapid hypertrophy of visceral organs including a 40% fully reversible increase in ventricular muscle mass within 48 h after feeding (2, 31, 32, 33). The large factorial scope and prolonged period of the postprandial response allows for a good resolution in physiological studies on fundamental mechanisms of digestion that apply to all vertebrates.

The cardiovascular responses to digestion in pythons include a doubling of heart rate and a fourfold increase in cardiac output, as well as a dilation of the mesenteric vascular bed leading to intestinal hyperemia (34, 42). Furthermore, plasma levels of gastrointestinal regulatory peptides increases manyfold after feeding (35). Compared with humans, where the nonadrenergic-noncholinergic (NANC) contribution to postprandial heart rate is modest, it contributes significantly in infrequently feeding snakes, such as pythons and boas, making them convenient animal models to study postprandial regulation of the heart (47).  [...]

 

 

Edited June 20, 2019 by Sibiriak

[mccoy]

20 hours ago, Gordo said:

You should get a heart rate variability monitor - they are pretty cheap and can actually tell you a Lot about your health and rate of aging (as well as tracking heart rate). See the thread here on that... 

Gordo, I'm looking them up at amazon, although here in Italy I only see one model.

[mccoy]

Re. The article on phytons; I found very interesting the following reference:

 

Quote

In line with the August Krogh principle, which dictates that for many physiological problems there will be an animal of choice on which it can be most conveniently studied, the pronounced and long-lasting effects of digestion on cardiovascular control in pythons may reveal fundamental mechanisms of digestion that apply to all vertebrates.