Carotid Artery Occlusion

Carotid atherosclerosis is one of the main risk factors for ischaemic cerebrovascular events (CVEs).

The area of the carotid artery most commonly affected by atherosclerosis is the bifurcation of the common carotid artery.
The full article can be found here

Data from randomized controlled studies regarding the efficacy of carotid endarterectomy in older patients are limited. NASCET, for instance, was limited to patients aged <80 years and only 14% of all randomized patients were ≥75 years. Similarly, only 6% of all randomized patients were ≥75 years in the ECST.  Get the full story here

Carotid Artery Blockage Is a Scary Situation

By Susan Goodwin

Carotid Artery Blockage is a condition characterized by the narrowing of carotid arteries. This can increase the risk factors for developing heart disease and stroke, which is one of the leading causes of death.

It is without doubt, a scary condition best avoided. Also known as carotid artery stenosis, blockage of the carotid artery is primarily caused by the build-up of cholesterol and fatty deposits on the arterial walls – deposits commonly known as plaque.

These are two of the most important blood vessels in the cardiovascular system. These two large arteries supply oxygen-rich blood to the frontal part of the brain. This large area of the brain is responsible for speech, think, sensory, personality and motor functions. Because these two arteries serve a very important function, problems in the carotid are best avoided.

Carotid Artery Disease Can Happen

Just like all the arteries in the body, it can also harden due to arterial plaque deposits. Over time, build-up of fatty substances, cholesterol, calcium, fibrin and other components in the blood can narrow down the carotid arteries. This building up can decrease the blood flow to the brain, which puts one at risk for developing a stroke.

The type of stroke which it can cause is oftentimes termed as "brain attack." When the vessels of the carotid are blocked, the blood flow into the front part of the brain is cut off. When the blood flow is halted for more than 3 to up to 6 hours, the damage to the brain is almost always permanent.

Symptoms of Carotid Artery Blockage

It is a serious medical condition. In fact, the blockage may exist for years on end before symptoms start to develop. Symptoms are usually subtle, and in most cases, the symptoms exhibit in the form of paralysis or "brain attack." Symptoms can include:

- Simply hissing sound

- Severe headache

- Temporary loss of hearing or vision (sometimes both)

- Sudden loss in motor coordination

- Temporary numbness usually on one side of the face, leg or arm

- Sudden difficulty in thinking, speaking and understanding

Most of these symptoms of carotid artery blockage are also symptoms of transient ischemic attack that is the absolute determinant of a complete carotid artery blockage.

The Seriousness of Carotid Artery Disease

If any of the symptoms of blockage are experienced, the patient should seek medical help immediately before the condition worsens. This disease can instantly manifest itself in the form of paralysis or stroke, in ways that are oftentimes irreparable.

Treatment of Artery Blockage

The treatment of carotid artery blockage would depend on the symptoms presented and the severity of the blockage. For cases caught early on where the level of blockage is yet to be damaging, medications and blood thinners are usually enough for a patient to get by. For more severe cases, however, more invasive procedures to remove the blockage (heart by-pass surgery or angioplasty) may be recommended.

Make sure to consult with your doctor immediately if you suspect carotid artery blockage. Better yet, talk to your doctor now about getting on a heart-health diet and exercise program, before you have any problems, because prevention is often the best medicine.

And remember that pure fish oil supplements can be part of a good overall diet and exercise program to support a healthy heart and veins and blood flow. Talk to your doctor and also read the latest news about fish oil, and you will see why it is so popular nowadays.

Susan Goodwin writes about fish oil health benefits at http://www.pureconcentratedfishoil.com where you can get a free report about fish oil and heart health. Be sure to choose a pure concentrated fish oil supplement that will provide you and your heart all the health benefits possible.

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Coronary Artery CT Scans & Cancer Risk
By Robert Wascher

It has been estimated by experts that up to 2 percent of all cancer cases are caused by exposure to medical x-ray tests. Although it is believed that there is no completely safe level of exposure to x-rays, it is well known that exposure to increasing doses of x-rays, as well as undergoing repeated x-ray examinations, increases the risk of cancer formation.

The increasing use of CT scanners (which can expose patients to significant doses of radiation) to screen asymptomatic patients for coronary artery disease has been a source of growing concern among many cancer experts. While the detection of coronary artery calcifications and coronary artery narrowing (stenosis) on multi-detector CT scanners are powerful predictors of future cardiac disease events, it remains unclear, at this time, whether or not this approach to coronary artery disease screening offers any significant clinical benefits to otherwise asymptomatic patients.

A newly published clinical research study, which appears in the current issue of the Annals of Internal Medicine, further quantifies the potential cancer risk associated with the use CT scans to screen for coronary artery disease.

Because there are no nationally standardized protocols for CT scan cardiac screening examinations, the authors of this study considered several commonly used CT scan protocols, and then calculated the actual dose of radiation delivered to patients with each of these scan protocols. Using long-term data derived from Japanese atomic bomb survivors, the researchers then estimated the added cancer risk to patients receiving coronary artery screening CT scans.

One important (and concerning) finding from this study is that radiation doses delivered to patients vary by more than 10-fold among the different CT scan protocols in common use throughout the United States.

Based upon existing screening recommendations, the authors calculated the added cancer risk associated with adult patients undergoing coronary artery screening CT scans every 5 years between the ages of 45 and 75 years for men, and every 5 years between the ages of 55 and 75 years for women. Using the very conservative assumption that all patients are exposed to a dose of radiation equivalent to the average of all commonly used CT scan protocols, the authors calculated that the lifetime increased incidence of cancer was 4.2 new cases of cancer per 10,000 men, and 6.2 new cases of cancer per 10,000 women. Based upon the known effects of radiation to the organs contained in the chest area, approximately 71 percent of the cancer cases caused by CT scans of the heart would be in the form of lung cancer, while 20 percent of these "excess" cancers would be breast cancers induced in women. Another 12 percent of these radiation-induced cancers would be in the form of leukemia in men, while 4 percent of these otherwise preventable cancers would manifest as leukemia in women.

Unfortunately, there is currently no scientific consensus regarding the clinical benefit, if any, of using CT scanners to detect coronary artery disease in asymptomatic patients, as there is no high level clinical research data available to prove that this screening approach reduces cardiac disease events, or cardiac-associated deaths. Therefore, all that can be confidently said, at this time, about the routine use of CT scans to screen for coronary artery disease is that it is, undoubtedly, associated with a small but not insignificant risk of otherwise preventable cancers. Moreover, when you consider that the authors of this study used very conservative estimates regarding absorbed radiation doses in patients undergoing coronary artery screening, the actual cancer risk associated with many of cardiac screening CT scan protocols in current use is probably significantly higher than what this study predicts.

In my own case, I underwent two separate CT scans, to assess for both coronary artery calcifications and coronary artery narrowing (stenosis), as part of a "VIP Physical" in 2006. At the time, there was great enthusiasm for the routine use of CT scanners for this purpose. However, based upon the available data (including the data from this study), I have recently decided that I will not undergo any additional heart screening CT scans until and unless compelling clinical data comes along to suggest that the benefit from such scans outweighs their potential risks. If you have been considering undergoing a routine cardiac screening CT scan, my advice is to first discuss the data contained in this clinical study with your Internist or Cardiologist, and ask them to clarify both the potential risks and benefits, in your particular case, of undergoing a coronary artery screening CT scan.

Meanwhile more research is needed to clarify what, if any, health benefits can be reasonably claimed for routine coronary artery screening CT scans in asymptomatic patients. Finally, in view of the immense variation in radiation doses associated with the various CT scanning protocols in common use today, professional radiology societies and boards should quickly work to reach a consensus on standardizing these protocols in such a way that unnecessary radiation exposure is minimized.

By, Robert A. Wascher, MD, FACS
Updated: 07/26/2009
________________________________________
The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

________________________________________

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

Robert A. Wascher, MD, FACS

http://doctorwascher.com

Coronary Artery Calcium Scans Detect Early Stages of CAD
By Carolyn Strimike

Cardiovascular disease is the leading cause of death in men and women in the United States. Approximately 50% of acute myocardial infarction's occur in people without any history of coronary artery disease. Sudden cardiac death is often the first sign of coronary heart disease. Coronary atherosclerosis is a slow progressive disease that oftentimes goes unrecognized until the person develops symptoms. By the time symptoms start to occur coronary artery disease is usually in a relatively advanced stage requiring either percutaneous or surgical revascularization. The opportunity for disease prevention or aggressive risk factor modification is missed. What is needed is a way to identify asymptomatic people who are at high risk for cardiovascular events early in their disease process. Traditional cardiovascular risk factors are well established (elevated lipid levels, hypertension, smoking, obesity, lack of exercise, diabetes, family history heart disease) and helpful to predict future cardiovascular disease. Many people however suffer cardiovascular events in the absence of these established coronary artery disease risk factors.

Myocardial infarctions usually occur in patients who have a mild of moderate coronary artery stenosis that develops plaque rupture and leads to an acute thrombosis. These mild to moderate coronary lesions may not cause symptoms and/or may not cause enough ischemia to be picked up during a routine stress test.

During the early stages of coronary atherosclerosis calcium starts to accumulate within the plaque. As the atherosclerotic process progresses the amount of calcification increases. During the advanced stages of atherosclerosis a large amount of coronary calcification may be present.

Women have been reported to have less coronary artery calcification than men and the mean prevalence of calcification in women occurs about one decade later than in men, as does the incidence of cardiovascular events. The prevalence of calcium in adults 30 to 39 years of age is 21% for men and 11% for women, while in adults 40 to 49 years of age the prevalence is 44% in men and 23% in women. A recent study found coronary calcium scores were similar in African American and Caucasian women even though African American women had more risk factors. Diabetes mellitus and not exercising regularly was associated with increased Coronary Artery Calcium Scores in white women but not African American women. The overall prevalence of calcium in women is about half that of men until age sixty. Another study in asymptomatic women found that smoking, elevated total cholesterol levels, and hypertension were all associated with higher Coronary Artery Calcium Scores. Calcium deposits have also been found to increase with age irrespective of gender. Patients with diabetes and patients with end stage renal disease requiring hemodialysis have a higher prevalence of calcium. The more cardiovascular risk factors a person has the higher the prevalence of calcium.

Atherosclerosis is the only disease process known to cause calcium to deposit in coronary artery walls. Calcification is not a degenerative disease, it is not a part of the "normal" aging process. Calcium is not found in normal coronary arteries.

Since calcium deposits start to develop during the early stages of atherosclerosis and if we are able to identify the presence of calcium we are able to identify preclinical coronary artery disease during the asymptomatic stage. This can allow for the implementation of early aggressive risk factor reduction.

The calcium score screening heart scan is a non-invasive test that detects calcium deposits in the coronary artery walls. The test is performed with an electron beam cat scanner (EBCT) that permits very rapid scanning. The images are triggered with the assistance of ECG monitoring during diastole and a several second breath hold to eliminate motion artifact. The actual scan only takes about thirty seconds and computer software then quantifies the calcium area and density.

The EBCT detects the presence, location and extent of calcium deposits in the coronary system. Separate calcium scores may be obtained for the left main artery, left anterior descending artery, left circumflex, and right coronary artery but the total calcium score is most important. The EBCT can detect miniscule calcium deposits which is what is usually present with early coronary artery disease. The presence of any coronary calcification signifies coronary artery disease. People with low total calcium scores are at a lower cardiovascular risk than high scores.

Calcium scores range from zero (no plaque) to several thousand (extensive plaque) and is a unitless measurement calculated for the entire coronary system. A calcium score of zero indicates the absence of any calcium and an extremely low likelihood of obstructive coronary artery disease. A calcium score greater than 400 signifies extensive calcification and a high likelihood of significant coronary artery disease. (See Average Calcium Score Chart) These people should undergo further evaluation with exercise stress test or nuclear stress test for myocardial ischemia. The higher the total score the greater the overall plaque burden. Asymptomatic people with an intermediate calcium score require a thorough risk assessment and individualized risk factor modification. A person's age and gender also need to be considered when evaluating the calcium score results. A calcium score of 175 may be average for a 65 year old male but grossly abnormal for a 55 year old female.

The calcium scoring scan is not able to identify the location of a significant coronary artery lesion nor identify the percent stenosis. The quantity of coronary artery calcium predicts the total atherosclerotic plaque mass and likelihood of developing future cardiovascular events. Coronary calcium has been reported to be an independent predictor of stable angina, myocardial infarction, cardiovascular death, and need for coronary revascularization. A study in asymptomatic adults 20 to 69 years old found that at 18 month follow-up the myocardial infarction and cardiovascular death rate was 6.6% in people who had any calcium present on scan versus 0.9% in people without any calcium. There is a direct relationship between increasing calcium scores and the occurrence of adverse events. Asymptomatic people with very high calcium scores (> 1,000) have been found to have an approximately 25% risk per year of developing a myocardial infarction of cardiovascular death. A recent study of asymptomatic adults over 45 years of age with at least one cardiovascular risk factor found a fourfold increase in cardiovascular risk in patients with coronary artery calcium scores greater than 300. A study performed on symptomatic patients found that a coronary artery calcium score greater than 170 was associated with an increased likelihood of obstructive coronary artery disease regardless of the number of risk factors present.

A recent meta-analysis reported a 92.3% sensitivity and 51.2% specificity for the accuracy of the EBCT to diagnose obstructive coronary artery disease. This makes the overall predictive accuracy approximately 70%. One advantage of the scan is there are no "false positive" scans, calcium deposits are only found in the presence of plaque. Interscan reliability of calcium scores has been questioned and has been reported to vary more with lower score. One study reported a calcium score variability of 28% in women and 43% in men when repeat scans were performed on the same individual. This really needs to be evaluated further and may be dependent on the facility, equipment of physician interpreting the results.

Non-calcified, soft plaques will not be detected by EBCT. Younger patients who are heavy smokers may not have calcium deposits present but are still at high cardiovascular risk and prone to spasm and thrombus formation. There has been some research to suggest that patients with unstable angina are prone to have fewer calcified plaques than patients with stable angina. Younger patients may develop a significant stenosis in the absence of calcification. This may falsely reassure people who are at high risk. There is not enough data to support using the coronary calcium scans in symptomatic patients of patients already know to be at high risk.

The coronary calcium scan (EBCT) is most useful in asymptomatic patients with intermediate risk, to help determine the need for aggressive risk factor management. (See Coronary Artery Calcium Scans chart below)

Traditional non-invasive tests to evaluate coronary artery disease (exercise stress test, nuclear scans, stress echocardiography) only detect coronary lesions that are severe enough to limit blood flow and cause myocardial ischemia. People with very mild coronary artery disease or early atherosclerosis will not be identified. Coronary calcium screening is able to identify non-obstructive mild coronary artery lesions before symptoms develop. Asymptomatic people with high calcium scores are also more likely to have abnormal nuclear stress tests indicative of silent ischemia. In one study 46% of patients with coronary artery calcium scores greater than 400 had an abnormal nuclear scan while 0% of patients with coronary artery calcium scores less than 10 had an abnormal nuclear scan.

EBCT scans may proved to be more beneficial for screening women. Many times women present with atypical symptoms and are more likely to have false positive exercise stress tests and/or nuclear scans. Calcium scoring scans have been reported to have a higher predictive value for significant coronary artery disease in women and less false positives than men. The negative predictive value in one study of symptomatic patients was 96% in women and 89% in men. Women with normal lipid levels are also more likely to experience angina/myocardial infarction than men. The standard lipid profile does not always adequately reflect a woman's cardiovascular risk. A study of asymptomatic women over 55 years of age with normal lipid levels found elevated coronary artery calcium score. This is an area that needs to be evaluated further but suggests that coronary artery calcium scores may prove to be very beneficial in assessing cardiovascular risk profiles in women.

Indications for Coronary Artery Calcium Scans:
1. Family history heart disease (especially premature heart disease)
2. History of smoking
3. Hypertension
4. Obesity
5. Elevated lipid levels
6. Diabetes
7. Men over 40 years old or postmenopausal women
8. Young people with atypical symptoms

Contraindications for Coronary Artery Calcium Scans:
1. Known coronary artery disease
2. People over 70 years old (little clinical benefit)
3. Pregnant women
4. Arrhythmias (Chronic atrial fibrillation, resting tachycardia – heart rate greater than 90 bpm) will
compromise image quality

Average Calcium Scores:
Men
< 40 years old 0
45 to 49 years old 0
50 to 54 years old 5
55 to 59 years old 36
60 to 64 years old 95
65 to 69 years old 201
70 to 74 years old 302
> 74 years old 521

Women
< 40 years old 0
45 to 49 years old 0
50 to 54 years old 0
55 to 59 years old 0
60 to 64 years old 0
65 to 69 years old 8
70 to 74 years old 28
> 74 years old 149

Carotid Artery Stenosis – Remedy With Tocotrienols Vitamin
By Michael R

Carotid artery stenosis is a kind of constriction of artery walls in our body. While many of us would have known about atherosclerosis, few of us have little knowledge about arteriosclerosis. This is very specific to arteries. Tocotrienols vitamin is a remedy for constriction of arteries in an important place in our body.

Don't get into hypertension. If you do not control, that is the main reason for stiffening of arteries. Once the artery stiffens and becomes hard, it will lose its elasticity. This condition is known as arteriosclerosis. I am not too sure how far this is true if someone tells that calcium deposits are responsible. Leaving aside the causes, the important point to note is that, for one reason or the other, some of us might land up with arteriosclerosis and get into cardio vascular problems.

If you experience sudden weakness or dizziness quite often, even before you approach a physician, know that in all probability you are affected with arteriosclerosis in the carotid artery. It is an artery in our neck that supplies to our neck and the head with oxygenated blood. Once the blood flow is affected, you have the said symptoms caused by carotid artery stenosis.

Though this artery is in the neck, you will be surprised to know that the pulse of this artery only will clearly establish the cardiac function. In many cases, this comes in handy for the physician to assess the functioning of the heart when periphery arteries do not give clear signal of the pulse.

If the oxygen is not supplied to head and the neck, ischemia is imminent. The tissues will start to die. This condition will have serious consequences including leading to stroke.

There are few potent isomers which have the capacity to reverse the carotid artery stenosis. They are found in tocotrienols vitamin.

The tocotrienols is present in nature at very low level. So, it may not be possible to get the isomers in adequate quantity. Also you should know that not all tocotrienols have the isomers to reverse the arterial blockage. Only that is extracted from palm fruit has the ability. Again, one cannot drink palm oil to get the benefit. The obvious choice is to go in for tocotrienols supplement.

When choosing the right nutrition supplement, you should be very careful not to fall pray to cheap products that claim to contain all natural ingredients. First of all you should understand that the supplements should be produced in a GMP compliant facility. Also any nutrition supplement should be taken in a complete planned balanced dosage. Any nutrition for that matter, if taken more than the adequate level is neither going to add value nor leave you unhurt.

I know for sure, a fantastic nutrition supplement that can address the problem of carotid artery stenosis. It has more than seventy ingredients. All these are sourced from hundred percent natural resources. Each and every ingredient is properly combined to give the best nutrition benefit in a GMP compliant facility. Go and visit my website to know more about unique nutrition information like tocotrienols vitamin and you will immensely benefit for the time you will spend.

Michael Ryan is an expert on nutritional supplements and has over 30 years experience in the health and wellness industry. Check out his web site at http://www.nutritionflash.com to find out which nutrition and vitamin supplements you must consider taking.