Hello there! I'm Dr Reza Moazzeni, from Sydney, Australia, where I practice cardiology. My approach to medicine is rooted in value-based care, and I firmly believe that "healthcare is at its best when we offer our assistance to those who actively seek it".
In today's world, visual education techniques have proven to be highly efficient and have made traditional teaching methods outdated. The well-known phrase "A picture is worth a thousand words" can be updated to "A video is worth a thousand written materials."
The information presented here is aimed at both the general public and medical professionals. However, if a specific video is geared towards medical professionals, I will make that clear in the beginning.
It is important to seek guidance from your healthcare provider before altering your current treatment in response to the information presented here.
If heart beat rate is high at that time when echo-cardiography is performing can a doctor able to detect heart hole or valve related problems with rapid heart beat 120-130 bpm..
So,if I have a calcium score of 1073 but no symptoms,I don't need a CT angiogram?I'm afraid if I exercise too hard I may have a heart attack,if my artery is near blocked.
You should go for CTCA to see the blockages.If you have no symptoms then probably no blockages.Also go for exercise stress test before starting any exercise. When was your score of 1000 plus diagnosed?
A high CAC score like yours means you are at high risk and need perfect management of your risk factors and medical therapy. It does not necessarily mean you have "blockages," and by "blockages," we mean those that will limit the flow of blood (severe blockages). Study after study has shown that opening these blockages with a stent or surgery does not necessarily reduce the risk of a heart attack. However, what does reduce that risk is intensive medical therapy and lifestyle changes. With high numbers like yours, we usually recommend a "functional test" such as a stress echocardiogram. If your exercise tolerance is reasonable, at a good workload according to your age, and there is no evidence of severe ischemia on ECG or echocardiogram, then all you need are intensive lifestyle modifications (plenty of exercise and a healthy diet), weight loss, and medical therapy to control your risk factors (including statins and aspirin, if needed), as well as regular follow-ups with a specialist. SRESS ECHOCARDIOGRAM: heartcare.sydney/stress-echocardiogram/ CORANY CALCIUM SCORE: heartcare.sydney/what-is-coronary-artery-calcium-score-and-when-is-it-indicated/
Amazing. From USA. I canceled my angiogram yesterday because I have no pain. The cardiologist said I could get one but i don’t have any pain. I had a week long cruise and was going to cancel. I had a cac score of 800. I am on statins, plus eztimibe, plus aspirin.this makes me feel better. Thank you most heart fully.
Unfortunately the misuse of calcium score is common. The calcium score is NOT a test to decide whether someone angiogram or stent. It is just a RISK ASSESSMENT TOOL. If Zero --> can be reassuring in "low-risk" people. If high --> means high risk and the patient needs INTENSIVE MEDICAL THERAPY to lower the risk Any decision to proceed with an angiogram or further invasive procedures should ONLY be guided by symptoms or the presence of a significant abnormality on a functional test like stress echocardiogram. A calcium score should never lead directly to an invasive angiogram.
This is wonderful, but it appears to me, according to the video, now you have a bunch of PCSK9 proteins bonded to antibodies floating around in the plasma (@3:21). What happens to these bodies as they build up over time? Can they form clots of their own? Are they ever broken down. Etc. It seems to me that a lot more research needs to be done before this is hailed as a miracle solution.
Is the calcium scoring done by computer or by a human reading it? In other words, will two radiologists come up with the exact same score on a CAC test of the same patient?
Absolutely brilliant! Thank you so much as your video helped me understand a part of my cardiology class which seemed complex, until you made it extraordinarily easy to understand. I appreciate the extra details and definitions that also helped me better grasp other concepts! - a med student from France
Thank you for your very well laid out descriptions. I find your videos concise, easy to follow, and wonderfully answering many questions. I did not know that the CAC score was not useful and why, you explained it. As an RN, FNP, even I find it hard to muster up the right questions for my cardiologist. I am a pt, had a low dose CT showing severe coronary calcium, last CT was 2 years prior, then 1 yr prior x2 showing normal age related calcium. I was wondering, I’d never thought of this before but can you see pts in the USA, via telahealth? I think it would be helpful for my better understanding of my cardiac health? Thank you, William
I'm glad you liked it. A Lipoprotein a [Lp(a)] level of 490 nmol/L is extremely high, putting the patient at a very high risk of future cardiovascular diseases, such as heart attacks or strokes. Unfortunately, we don't yet have a specific treatment for Lp(a), but we recommend statins, aspirin, and significant lifestyle changes to reduce the risk. Currently, there is no treatment on the market that specifically targets Lp(a), but this is expected to change in the near future. PCSK9 inhibitors can reduce Lp(a) by about 20%, and inclisiran by about 25%. heartcare.sydney/inclisiran/ heartcare.sydney/pcsk9-inhibitors/
AR stands for Aortic Regurgitation. It's when the Aortic Valve does not close (shut) properly and a small amount of blood, leaks back to the heart from the aorta. If mild, no therapy needed, only regular surveillance, every one or two years. The more severe cases, need closer follow-ups.
Thankyou Dr. I’m a 75 yo Oral Surgeon, still working, office outpatients only. Ca score 650. No chest pain. T2 DM. Doing keto. Lost about 90 lbs over last 18 mo. I have been struggling with/idea of d/c ing Rosuvastatin. So thankful I viewed your video. Thankyou!
@@dx398 my doctor said that the angiogram is more accurate and to go off of that. Not sure where the 240 came from but is alarming when you have 2 different numbers and apart by a lot.
The difference is significant and not normal. CAC scores should be pretty much the same: Whether you get a CAC scan or a CTCA, and they're done on the same machine, the calcium score you get should be about the same. The way these scores are figured out follows a set plan, so the numbers from both scans should match up closely. Small differences can happen: Things like how you're positioned, how well you hold your breath, or changes in your heart rate can make your CAC score vary a bit. These small changes usually don't make a big difference in figuring out your overall risk. Different places might give slightly different scores: If you get your scans at different radiology centers, you might see a little difference in your CAC scores. This can be because of the different CT scanners, how the scans are done, or the software they use. But these differences should be pretty small.
@@heartcaresydney thanks for the response! Where I got my CAC was at a place called boardwalk. I then went to Baylor to get my CTCA. They were 2 different machines. Any suggestions? Should I have my Dr re-review both scans? He’s adamant that the Angiogram (both my Cariologist and Physician) that I want to go off the Angiogram scores. They were taken 2-3wks apart
Given the CTCA takes a couple of minutes longer & provides the CAC score as well as the more detailed analysis I’m not sure I understand why any cardiologist would only request the PT CAC only.
Hi, you raise a valid point that I have addressed in my blog post under the "frequently asked questions" section: heartcare.sydney/what-is-coronary-artery-calcium-score-and-when-is-it-indicated/ While CTCA provides more information, the most important reason for choosing a CAC score in certain cases is to avoid overdiagnosis and overtreatment. We see many cases in practice where a CTCA was performed in asymptomatic patients, leading to severe anxiety or invasive treatments that were not needed, sometimes resulting in complications. In the past 20 years, there has been a significant shift in our understanding of "coronary blockages." The presence of a "blockage" does not always necessitate an intervention, especially in the absence of symptoms or specific characteristics. The preferred approach for treating ASYMPTOMATIC coronary disease is intensive medical therapy, and a healthy lifestyle and CAC score is just another tool in the box for the risk assessment. Ultimately, the decision between a CAC score and CTCA should be made on a case-by-case basis, taking into account the patient's individual risk factors, needs, and the clinician's judgment.
This notion that some blockages can be managed with medical therapy and do not need intervention sounds risky. Given the risk is person having a heart attack and potentially dieing. This is one of those things where over diagnosing and over treatment will be perfectly fine with me 😊
@@Desihealthpk While the urge to over-diagnose and over-treat for 'peace of mind' is understandable, it's crucial to weigh the potentially severe and, at times, life-threatening risks associated with invasive procedures that are not uncommon in daily practice. Numerous studies have shown that for many patients with stable coronary disease, optimal medical therapy and risk management are just as effective as interventions in preventing heart attacks. What primarily prevents a heart attack is medical therapy and risk management, not just placing a stent, which addresses only one specific area in the coronary arteries and ignores the rest of the coronary anatomy. Stents are crucial when a severe blockage causes symptoms or is located in a critical area-situations where immediate intervention makes sense. However, for many people, managing the overall risk through medication and lifestyle changes is equally effective in preventing heart attacks without focusing on a single lesion.
The question I have is instead of having to be subjected to these invasive tests.... Yes the CT scan with contrast dye is very invasive plus the physicians prescribing these test nor the diagnostic centers or hospitals are doing the required (not suggested) testing of kidneys first! So they can see a little bit better… They were able to read the CT scans perfectly fine before so why should we subject our bodies to these harsh chemicals just so they can see better… ?!! I was searching on here for my father in law and personally I’d rather have the calcium scoring or an mri that any CT...even an ultrasound ! Too much radiation and very expensive diagnostic as well as invasive ! We have technologies that are so advanced they should be able to see it quite clearly and I’m not sure why it is not bright enough to be able to read it. Moreover with the med beds coming out once ‘disclosure’ happens… We won’t have to worry about anything and they already have technology to create organs that can be created from our own DNA of a 20 year old organ within minutes! there will be no harvesting and black market of organs that is happening in children as I speak. I’m certified in human trafficking so I know what’s going on and it is horrific and once people find out which will be soon people will be taking their lives back! Just like in the movie “avatar” we have med beds that are just sitting there waiting to be dispersed that the military is already using. Also since the ‘dark act’ was passed during the Clinton administration all these additives that are they are putting in our food so that they can hide easily because it’s not put in when it’s manufactured it’s added later so they can pop the label “no added ingredients” on the packaging… Further being deceptive and causing people to escalate into all kinds of sickness and diseases including leaky gut syndrome Crohn’s disease etc. this all constitutes high cost of medical bills, long waits for diagnostics in between follow up appointments as well as our gas and time, wear & tear on our vehicles and stress of not knowing and waiting on the interim. A famous cardiologist, Dr. Stephen Gundry can attest to all this and this is the reason why he now focuses on preventive health and quit his job as a famous cardiologist who even invented some of the technologies they use in heart transplants! He has ads all over yt & very informative infomercials! Smart man! If your like to know what’s going on and even what’s upcoming watch Dt. Michael Salla Of Exo Politics dote .org as well as his interviews on his channel with Insiders from the Army Special Forces who can attest to these “Med Beds” already manufactured that many of the military get to use as well as elitists who have kept this very advanced technologies hidden from us - all at our demise and their profit . TY for sharing this about the differences but honestly I’d rather not have to have any of these and just eat healthy and exercise and drink tea from Aryvedic Medicines that naturally clears plague from arteries one week per month ! Cinnamon, fr SH garlic, grated ginger root and lemon❣️ Enjoy the Journey 🤣🌈🚀🦋🌎💞🙏🏻👽🛸🥰 @MichaelSalla @DrGundry @JPjpJP1 @ElenaDanaan
PCSK9 inhibitors are considered safe and effective for most people and no serious or life-threatening side effects have been reported. The main side effects are related to injection site allergic reactions and occasionally flu-like symptoms. heartcare.sydney/pcsk9-inhibitors/
Totally agree with you. Nothing beats a healthy-lifestyle. I usually reserve medical therapy for those who have developed heart disease, despite their best efforts or due to genetic predisposition. Although a healthy-lifestyle is crucial, it doesn't fix a heart attack!
I don't use statins. Age:early 60s. D2M ~22 yrs. A1c-6.2 for 22+ yrs. Total Cholestrol~175-185mg/dL all along. BP:120/80. Vegetarian. What may be my cal score? 2900 with no chest pain even if I climb mountains or 1000 steps. Yes, all of my arteries are calcified from 500 to 800. NO one in my family have HEART DISEASE. This means, I assume that most of my plaques are NOT SOFT PLAQUES but mostly hard & stable ones. I have a plan of what to do next.
Thanks for the clear explanation! I got a CAC score recently of 200. Should I now get a CT angiogram to determine if the are any blockages if I do not have any symptoms?
And that is elevated cholesterol?? I also workout often, eat lowcarb, im not diabetic, my total cholesterol was 667 mg around seven months ago, and now im at 330... My parents have normal cholesterol levels
Notice the absence of any mention of diet and lifestyle changes, the role of insulin resistance on metabolic health and the lack of a causal link between LDL and heart disease - this video demonstrates how your doctor is actually taught by big pharma: it’s just drugs, drugs and more drugs always drugs…… I recommend watching David Diamonds videos discussing the side effects of statins, how they cause diabetes which is the number one cause of heart disease and kidney disease, and how the CORRECT dietary habits and exercise can actually solve the root conditions and produce true health and longevity in most people. But of course no one is getting rich on that message
Thank you for your comment. I want to clarify a few aspects of the video to address your concerns: * This video is specifically about PCSK9 inhibitors and how they work. Its purpose is to educate viewers about this particular type of medication. However, it doesn't aim to cover all aspects of managing cardiovascular disease, such as diet and lifestyle modifications. * PCSK9 inhibitors are for established CAD patients, such as those with a history of heart attack, bypass surgery, or familial hypercholesterolemia. These are for secondary prevention in high-risk individuals, not primary prevention in low-risk people. * I always advise my patients to adopt a healthy lifestyle as the primary approach to heart health (heartcare.sydney/how-to-prevent-a-heart-attack/). However, it's essential to recognize that there are patients who, due to various circumstances, may not be able to engage in these lifestyle changes fully. Additionally, there are individuals who, despite leading a healthy lifestyle, remain at high risk for premature CAD due to genetic or other risk factors. In such cases, medical therapies like statins and PCSK9 inhibitors become a necessary part of their treatment plan to manage risk effectively. * Lastly, remember that taking medication is a personal choice and not an obligation. You can choose not to accept them if you feel they are not for you.
Thank you! I have been researching for a few months (family history and ASCVD, in spite of many years of vegan whole foods eating, daily exercise of running and/or resistance training, meditation, etc, etc). Lp(a) of 192 and a current stent have me seeking more data about treatment options. This is definitely the clearest explanation I've find to date re PCSK9 inhibitors.
My Calcium Score came in at 1571. Of that 509 LDA and 1024 Right , Thought I was toast. Cath angeogram showed only mild 10% or less stenosis. 41 years of statins thank you. Calcium was in the outer wall .. stable . Very fortunate . Dad 5 bypasses early 50's. All 6 uncles heart attacts 40's 50's.
I just did calcium score and angiogram.. score was 405 ,angiogram was good as I had 3 stents put in two years ago .. I also had fatty liver ..so I stopped sugary drinks processed foods and went on low carb diet incorporated intermittent fasting.... I’v heard statin increase calcium score so don’t think I’ll start taking them.. I lost 18 kg over last two years and my angiogram shows no more worsening stenosis.. ie still same as two years ago ..I’m worried statins will increase calcium score.. iv managed to keep cholesterol at normal levels.. ldl 2 ,, triglycerides at 0.8 and hdl 1.4 .. so triglycerides to hdl ratio is great
Hi, you have done a fantastic job losing 18 kg by following a healthy lifestyle. Coronary calcium scores are recommended in occasional, ambiguous cases to assess "future heart disease risk". For individuals with a history of cardiac events, like heart attacks, stent placement, or bypass surgeries, this test is not helpful, as their high-risk status is already established. For high-risk individuals, such as yourself, with a history of stent placement, statins are highly recommended. This is regardless of an LDL within the normal range. Your current LDL is within normal bounds, but an ideal target for someone in your situation is below 1.4 mmol/L. Ultimately, your treatment choice is personal. However, based on current evidence, statins are highly recommended in your scenario. While they may increase coronary calcification, overall, they reduce the risk of future events.
Thanks.. but I don’t understand why it has to be 1.4 .. ldl .. my cardiologist is angry with me for not taking statins too .. I lowered my cholesterol naturally with exercise and diet.. I don’t understand what statins will do that is more beneficial.. I totally reversed fatty liver as my enzymes were high alt and ast were 87,90 .. I reversed it with fasting and diet no more sugars and high carbs.. so I feel I eliminated the risk factors that caused my condition..also taking bit k2 d3 to try eliminating calcium from arteries
@@cpchris2 I truly commend the efforts you've made. Lowering your cholesterol naturally, reversing fatty liver, and lifestyle changes are incredible achievements that have undoubtedly reduced many risk factors. However, it's important to recognize that still a residual risk remains. Statins are recommended because they can further reduce this residual risk. The LDL-C target of 1.4 and below is not arbitrary; it is based on extensive research from large-scale trials conducted on hundreds of thousands over the past three decades. The evidence for its benefit is strong. To put it in perspective, if I had three stents, I'd aim for an LDL-C even below 1 mmol/L. I understand your reservations, and as always, the final decision is yours to make. The best choices are informed ones. Stay well.
