Where's our resident doctor? He is always honest and straight to the point.
Sorry Sam, I was just waiting till the thread got some semblance of rational discussion.
First and foremost, you have to understand that in a heart attack (ie acute myocardial infarction), the heart muscle is ACUTELY starved of oxygen and start to die (infarct). This usually happens because of a clot forming in the coronary arteries. You can actually have very minor coronary artery blockage or major coronary artery blockage on an angiogram and still have that clot forming. Often it is because of a cholesterol plaque rupturing and the clot forms on it. This is for heart attacks. The ones that kill you.
Angina is where coronary arteries are blocked. If you stress your heart and increase its oxygen demands, the coronary arteries may not be able to supply the blood flow and hence oxygen to the heart because of the blockage. Increase demand, supply cannot keep up. The heart starts to feel painful (angina) due to this. You stop running or stressing, the demand drops, the supply is enough. The heart muscle recovers. This is what treadmill tests detect.
Now the treatment for someone who is ALREADY in myocardial infarct ie heart attack can be angioplasty. They go in and balloon away to clot blockage. Put in a stent, save the heart muscle. Or it can be use of blood clot busters fibrinolytic drugs given intravenously. This is a life saving procedure. If you are already having a heart attack you will die in a couple of hours. So the discussion for that patient is probably not in this acute emergence situation. This one, talk about coq10 and red yeast rice extract no point lah. Sure die. Ok so that is emergency. Having heart attack. Of course if saved, and found many other vessels blocked etc, can also discuss coronary artery bypass graft (CABG) later.
Now what is also common is a guy is worried about his heart. Goes to a cardiologist and says he wants to check it out. Or has some chest pain and wants it checked. Do treadmill. Unsure or positive result. (Most private cardiologists in Singapore will say unsure). Then offer angiogram. Now when you do an angiogram there is a risk of having a stroke or heart attack. Small risk ( I dunno the numbers). But it is there. This is why it makes no sense to do it on a healthy young man. He is ok good, you go do angiogram then he kena stroke or heart attack. Is that acceptable? Of course not lah. So usually will do treadmill if show some signs then do. Or if the patient insists and still accepts risks (obviously he must be symptomatic or have strong family history, smoker or something to justify the off chance of stroke and heart attack) then we'll do it. There are those Heart MRI/CTs but I really dunno too much about the evidence behind it.
Anyway I digress. The angiogram is usually scheduled with consent taken and also consent for stent if they see a "significant blockage". Reason being is that if you do angiogram once you got that risk of stroke and heart attack. You do it twice your risk doubles. So cardiologist will say, if I see block I straight away put in stent ok? Save you the 2nd angiogram and risk again. Smart marketing tactic also by the way. Now what is "significant" depends on the cardiologist lah. I mean really he is the one that reports the angiogram and the % block and also the one who puts in the stent. In private sector, who will check on the cardiologist? In public sector got more checks and balances lah.
Now bypass surgery is when the blockage is too long for a stent. Imagine the whole vessel all blocked all the way. Or segment very long. Or so many vessels blocked. Then using a bypass graft is an option. There also also other indications where I cannot remember exactly about the studies that show that stent in patient with diabetes usually do not do well or is it vice versa. I am not a cardiologist so you best listen to the experts on those small details.
So Seee3 is in some sense correct when he talks about people who are still walking around despite 100% blockage. This is because of neovascularization. If the blockage process is gradual enough, the heart learns to produce new coronary vessels that will "bypass" the blockage itself. They tend to be very small and sometimes cannot be detected on an angiogram.
I suggest anyone having coronary artery vessel problems consult a cardiologist.
Those people who have heart failure, that is when the heart fails in its function as a pump. It is a total different discussion. CoQ10 is supposed to have some benefit for patient with congestive heart failure. Not coronary artery disease. Although one of the causes of heart failure is previous coronary artery disease or acute myocardial infarction.
Chelation therapy has not been proven in clinical trials but there are lots of anecdotal reports. I once worked with a guru in alternative medicine. I ran his regular clinic and he did all the alternative stuff. It was under him that I also got my fellowship in applied clinical nutrition. This therapy is considered experimental and doctors are not allowed to offer it without a special application for a research trial.
I have read all the criticisms about doctors not learning nutrition and all that.
Well here's the thing. In Singapore, family doctors are paid so little for consultation. It is not time based either. In fact most patients have no idea what "consultation fees" are. To them go doctor is to buy medicine. Hence all the jacked up medicine prices. It is to make up for the low consult rates. When it comes to these nutrition and alternative stuff, the only way you can profit from it is by selling the nutritional products or offer "illegal treatments".
I found that all those nutritional products so to speak.....well guess what, they are more expensive than your medications. It sounds very nice to seem like you are "smarter" than everyone else cos you take all these "special" products that other doctors don't offer their patients. Yeah but you pay way more also. And on top of that there is no evidence for it.
I could not in good conscience sell to average HDB heartlanders these products that cost 10 times more than the conventional medication which they already were not keen on taking. So really this whole "alternative" treatment to me is just a play on the rich. Make them feel special. They take this special treatment while the poor cannot. In the end there is no difference as Sam said we all have to die.
Oh yes, and if you are thinking "I have the last laugh cos I take all these special nutrition, exercise regularly and my risk of heart disease is near zero" , well guess what, it is VERY LIKELY that you are gonna die of cancer. I am very serious.
Excessive exercise ( I cannot remember the definition) eg running marathons weekly that kind of thing, produces lots of free radicals. These can damage cells. This is why often these highly fit individuals get cancer. Next time just watch your friend who is that fitness freak with little body fat and very fit. See if he kena cancer in the end. And in some cases when they are young. It is devastating to them. Because they worked so hard thought they were the epitome of fitness and health and then cancer strikes. They cannot understand it.
As a doctor, one has to decide what path they want to go on. I chose the conventional path. I can be a good salesman, but I rather stay on the side of the law. My quest for knowledge is to understand my patients. Those who think they will know more than me, will find out otherwise. But it helps with the overall conversation. TCM is another branch.
Family doctor in Singapore hard life. Everyday see cough and cold sell antibiotics. Consult fees like $5-$10. So quickly see, quickly sell antibiotics. Who willing to pay $250/hr for me to explain all the nutrition stuff to them then spend another $1000 a month on all the super supplements?
Talk is easy. You try doing as a doctor lah. Cars and houses expensive in Singapore leh!
Life is way better in Canada.
