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My Question For Wake Cardiologists

can I hijack this thread to ask about Total/HDL/LDL cutoffs? I had one doctor tell me total should be below 200, and 2 different doctors have told me LDL should be below 100 and 130. For the HDL levels, I've seen 60, 50, and 40. My recent numbers were 182, 51, and 113.
 
tsywake said:
Just curious, was it from a traumatic injury or just discovered by his Dr?
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definitely a traumatic injury.
he was climbing, and pulling an overhanging move (read: intense spike in blood pressure). felt a pop, jaw locked up, intense pain- thought he was having a heart attack, but was only 28 at the time and who has that at 28.
stopped climbing for the day, laid low and smoked a LOT of pot over the next 3 days (not abnormal at the time). woke up in the morning 3.5 days later, thought he was going to die. went to hospital. explained the feelings to a doctor, they did an ekg or CT (one of those), and within 2 hours he was being wheeled back to surgery. (included the note about the pot because the doctor recognized that his decreased blood pressure from smoking that much probably saved his life)
12.5 hours open heart surgery, packed in ice twice. finally closed him up because it was just too long under the knife, fully expected him to require another surgery in 6 mo. miraculously healed the rest of the way (as indicated by all known tests) over that time. heart surgeon at duke has never seen it happen before.

...yeah, you could say it was traumatic.
 
iodeac said:
can I hijack this thread to ask about Total/HDL/LDL cutoffs? I had one doctor tell me total should be below 200, and 2 different doctors have told me LDL should be below 100 and 130. For the HDL levels, I've seen 60, 50, and 40. My recent numbers were 182, 51, and 113.
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Wow. There is certainly some disagreement out there, but I'd like to hear their reasoning. I'm assuming you are a relatively young, healthy guy (I think I've seen marathon pics?). If that's the case, the generally accepted LDL goal is <160. Unless you have some risk factors I'm not aware of, your numbers are just fine. Don't worry about your total cholesterol. As far as HDL, generally speaking, the higher the better, but <40 is considered low.
 
To the original poster, no symptoms, normal ECG, no need for stress echocardiogram.

Regarding cholesterol, total cholesterol means nothing. Goal triglyceride level for everyone is less than 200. Goal HDL is as high as you can go but is mostly determined by genetics. Some medicines and exercise can help raise HDL a little. HDL levels less than 40 are considered low, while levels greater than 60 represent a negative cardiac risk factor. LDL is a moving target, one that seems to me moving lower with time and the publication of highly powered randomized clinical trials. Goal is now less than 130 for people without cardiovascular disease or a risk equivalent such as diabetes or kidney disease and as low as possible for patients with cardiovascular disease or a risk equivalent, with pharmacologic therapy initiated for these people whose LDL is above 100.
 
meandmyuncleDeac said:
He described it as a procedure where you have some substance injected, then you get on a treadmill, and they watch this substance travel through your heart, etc., under varying degrees of stress and relaxation.
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quadrupledeac said:
To the original poster, no symptoms, normal ECG, no need for stress echocardiogram.
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The OP doesn't appear to be describing a stress echo, but rather a myocardial perfusion scan. Still, neither sounds like it's indicated. A GXT sounds more up the OP's alley, if anything at all.
 
DeacinBama said:
The OP doesn't appear to be describing a stress echo, but rather a myocardial perfusion scan. Still, neither sounds like it's indicated. A GXT sounds more up the OP's alley, if anything at all.
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Had no idea people are doing myocardial perfusion studies in their offices these days.
 
quadrupledeac said:
Had no idea people are doing myocardial perfusion studies in their offices these days.
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MPSs remain one of the relatively better reimbursed studies in all of diagnostic imaging, thanks - in large part - to the cardiologist lobby. It's not particularly surprising that this would be a cost effective move, particularly if they're offering it and presumably performing it on patients that don't necessarily need it.
 
lbE08 said:
definitely a traumatic injury.
he was climbing, and pulling an overhanging move (read: intense spike in blood pressure). felt a pop, jaw locked up, intense pain- thought he was having a heart attack, but was only 28 at the time and who has that at 28.
stopped climbing for the day, laid low and smoked a LOT of pot over the next 3 days (not abnormal at the time). woke up in the morning 3.5 days later, thought he was going to die. went to hospital. explained the feelings to a doctor, they did an ekg or CT (one of those), and within 2 hours he was being wheeled back to surgery. (included the note about the pot because the doctor recognized that his decreased blood pressure from smoking that much probably saved his life)
12.5 hours open heart surgery, packed in ice twice. finally closed him up because it was just too long under the knife, fully expected him to require another surgery in 6 mo. miraculously healed the rest of the way (as indicated by all known tests) over that time. heart surgeon at duke has never seen it happen before.

...yeah, you could say it was traumatic.
Click to expand...

There's a difference in traumatic aortic injury (TAI) and dissection. TAI is caused by rapid deceleration usually in motor vehicle collisions. It sounds like your friend had a dissection from hypertension. Unusual in a young person without an underlying condition. Has he been tested for connective tissue disorders? Like Marfan's or Ehlor Danlos syndrome.

The various pathology of acute aortic syndromes are overlapping and can be confusing. Here is an older article, but one I still often refer to.

http://www.ajronline.org/content/181/2/309.full

Here's one on TAI click on the PDF

http://radiology.rsna.org/content/248/3/748.short



ETA: I love that your friend discovered another use for medical marijuana.
 
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61raddeac said:
There's a difference in traumatic aortic injury (TAI) and dissection. TAI is caused by rapid deceleration usually in motor vehicle collisions. It sounds like your friend had a dissection from hypertension. Unusual in a young person without an underlying condition. Has he been tested for connective tissue disorders? Like Marfan's or Ehlor Danlos syndrome.

The various pathology of acute aortic syndromes are overlapping and can be confusing. Here is an older article, but one I still often refer to.

http://www.ajronline.org/content/181/2/309.full

Here's one on TAI click on the PDF

http://radiology.rsna.org/content/248/3/748.short



ETA: I love that your friend discovered another use for medical marijuana.
Click to expand...

i think they decided on Marfan's, and I know the rest of his family has since been tested. it wasn't something on his radar, but as far as hereditary things go his mom was adopted and there's not much known history there. we're definitely aware of the need to test our own kids some day (when we have them).
and yes, "medical" marijuana....
 
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