HeartCare – FAQs

What You May Not Know

Even if you do not have a family history of heart disease, you may be experiencing non-traditional risk factors such as high levels of lipoprotein (a) that may greatly increase your risk of experiencing a heart attack. In other words, you may be at risk of heart disease and not know it.

Questions About Heart Disease
1. How do I know if I have heart disease?
2. What is the significance of my family medical history?
3. My body scan or heart scan showed calcified plaque in my coronary arteries. What does this mean?
4. What is the difference between good and bad cholesterol?
5. I don't eat a lot of cholesterol; why is mine still high?

1. How do I know if I have heart disease?
You may NOT know if you have heart disease. Common symptoms are chest pain and pressure, shortness of breath, palpitations and dizziness. However, many people have no symptoms until they suffer a heart attack or stroke, or worse, they die suddenly. This occurs for 50 percent of men and 64 percent of women who suffer an initial heart attack or stroke.

If you suffer from symptomatic carotid artery disease, peripheral vascular disease (poor circulation in the legs), abdominal aortic aneurysm, or diabetes, your risk of having a heart attack is as high as that of someone who has already had a heart attack -- an increased risk of 20 percent or more.

2. What is the significance of my family medical history?
Heart disease may be congenital or acquired. There are genetic metabolic disorders found in the blood that result in the build-up of arterial plaque inside the coronary arteries that can rupture, causing a heart attack or stroke.There are also patients who do not have a known family history of cardiovascular disease, but may have significant metabolic abnormalities predisposing them to disease, or who already have atherosclerotic disease.

3. My body scan or heart scan showed calcified plaque in my coronary arteries. What does this mean?
We can interpret findings from body or heart scans that can show calcified plaque in the arteries. Depending upon the calcium score, the probability of risk for future coronary events can be assigned and behaviors modified.

4. What is the difference between "good" and "bad" cholesterol?
Cholesterol is a waxy, fat-like substance made in the liver and found in certain foods, such as food from animals, like dairy products, eggs, and meat. The body needs some cholesterol in order to function properly. Its cell walls, or membranes, need cholesterol in order to produce hormones, vitamin D and the bile acids that help to digest fat. But the body needs only a small amount of cholesterol to meet its needs. Health problems such as coronary heart disease may develop when there's too much cholesterol present.

"Bad" cholesterol or Low density lipoproteins (LDL) can cause buildup of plaque on the walls of arteries. The more LDL there is in the blood, the greater the risk of heart disease. "Good" cholesterol or High density lipoproteins (HDL) helps the body get rid of bad cholesterol in the blood. The higher the level of HDL cholesterol, the better. If your levels of HDL are low, your risk of heart disease increases.

5. I don't eat a lot of cholesterol; why is mine still high?
There are two ways of creating high cholesterol levels: (1) eating cholesterol and/or a lot of saturated fat, or (2) producing it because of abnormal liver metabolism. Even if you don't ingest cholesterol and saturated fat in your food, you may lack LDL receptors in your liver, which will result in a high cholesterol level. This latter condition can be treated.

Questions About Blood
1. What is the difference between advanced lipid testing and the usual blood tests?
2. Do I have to have advanced blood work done and an electron-beam CT scan before I can see Dr. Wong?
3. What is plaque and what causes it?

1. What the difference between advanced lipid testing and the usual blood tests?
Beyond the level of cholesterol and triglycerides routinely provided in blood tests, advanced testing provides more refined measures of other substances in the blood that paint a unique profile of a patient's risk. Genetic testing helps to personalize recommendations.

2. Do I need my advanced blood work done and an electron-beam CT scan before seeing Dr. Wong?
No. Having these studies done is not a pre-condition of being seen in our practice (although we may refer you to have one or both tests done later). We see many patients who have had neither study done or only one. Both the laboratory and the CT centers refer to us because of our deep experience in this area.

3. What is plaque and what causes it?
High blood pressure, diabetes, or high cholesterol begin to damage the endothelium, a thin layer of cells lining the arteries that keeps them toned and smooth, and that keeps the blood flowing without obstruction. Bad cholesterol, or LDL, contacts damaged endothelium. The cholesterol enters the wall of the artery. Your white blood cells stream in to digest the LDL cholesterol. Over years, the accumulating mess of cholesterol and cells becomes plaque in the wall of the artery.

Questions About Treatments
1. Aren't statin drugs sufficient for most people to prevent heart attacks?
2. If I have had a heart attack, what kind of follow-up treatment is necessary?
3. Why can't I just have a stent or bypass when I need one?
4. How are Dr. Wong's diet, exercise, and lifestyle recommendations different from what most doctors advise?

1. Aren't statin drugs sufficient for most people to prevent heart attacks?
Statins are generally good at lowering LDL cholesterol, but if plaque formation is caused by other disorders, such as the presence of a particular kind of small, dense LDL cholesterol, statins will not address the problem. This would require other forms of treatment.

2. If I have already had heart surgery, why is additional follow-up treatment necessary?
Medical procedures like stents and bypass operations only resolve the immediate problem. They do not address the source, or the underlying disease state that created the condition. If the problem is not addressed, the condition is likely to recur.

3. Why can't I just have a stent or bypass again, if and when I need one?
The idea of preventive treatment such as the kind provided by HeartCare is to establish a plan to AVOID a heart attack by addressing conditions that contribute to heart disease. Unfortunately, a large percentage of heart attacks result in sudden death, so you cannot depend on being able to have another stent or bypass.

4. How are Dr. Wong's diet, exercise, and lifestyle recommendations different from what most doctors advise? Dr. Wong's recommendations are tailored to each individual based on the abnormalities uncovered by their personal medical history and results from sophisticated laboratory tests. For example, some people can eat sweets and drink alcohol with relative impunity, while for others these behaviors exacerbate their problems. Surprisingly for some, a very low-fat diet may actually worsen metabolic problems and result in higher risk for heart attack or stroke.

Questions About Dr. Wong's Practice
1. What is preventive cardiology?
2. What does Dr. Wong do that is different from what most cardiologists do?
3. If I am happy with my current primary-care doctor and/or cardiologist, why should I see Dr. Wong?
4. What limitations does HeartCare have on insurance?

1. What is preventive cardiology?
The practice of medicine to prevent heart attack and stroke: (1) by diagnosing the genetic and environmental influences that can lead to disease, and (2) by treating those factors. The composition of plaque can be changed and plaque accumulation can be reversed.

2. What does Dr. Wong do that is different from what most cardiologists do?
We specialize in treating the one-third (some say as much as one-half) of the population that suffers from heart disease arising from nontraditional factors.* We specialize in assessing the genetic metabolic disorders found in the blood that result in build up of arterial plaque. This condition, known as atherosclerosis, can ultimately produce heart attack, stroke, and poor circulation. Once diagnosed, risk for future events can be assessed and treated.

*Traditional risk factors are cigarette smoking, high blood pressure, high LDL cholesterol, low HDL cholesterol, diabetes, and family history of premature coronary disease in first-degree relatives (parents, siblings, children).

3. If I am happy with my current primary-care doctor and/or cardiologist, can I see Dr. Wong?
You can definitely see Dr. Wong if you are happy with your current doctor(s). Since we do not provide primary care, we encourage our patients to have a primary-care physician. We often provide second opinions and routinely provide detailed reports back to the referring doctors. We have practiced cardiology for over 40 years and have treated every kind of cardiac-related problem and are open to consulting with primary care doctors and cardiologists about mutual patients.

4. What limitations does HeartCare have on insurance?
Although we accept most insurance, many insurance companies, including Medicare, refuse to cover more than one procedure per year, and if we must repeat these studies, the patient is liable. We ask for a release to obtain your cardiac-related studies and laboratory work from the recent past. Often an older test can help provide a baseline as well, so we can measure progress. With a signed release, we can usually obtain records within a day or two.

Glossary Reference

Glossary

Disease States

Angina
Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. Angina is a symptom of a condition called myocardial ischemia. It occurs when the heart muscle (myocardium) doesn't get as much blood (hence as much oxygen) as it needs. This usually happens because one or more of the heart's arteries (blood vessels that supply blood to the heart muscle) is narrowed or blocked. Insufficient blood supply is called ischemia.

Aortic Aneurysm
An aortic aneurysm is a bulge in a section of the aorta, the body's main artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is stretched and weakened, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death.

Aneurysms can form in any section of the aorta, but they are common in the belly area (abdominal aortic aneurysm) and upper body (thoracic aortic aneurysm).

Atherosclerosis
Atherosclerosis (ath"er-o-skleh-RO'sis) comes from the Greek words athero (meaning gruel or paste) and sclerosis (hardness). It's the name of the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque.

Cardiovascular Disease
Cardiovascular disease includes a number of conditions affecting the structures or function of the heart. They can include: coronary artery disease (including heart attack); abnormal heart rhythms/arrythmias, heart failure, heart valve disease, congenital heart disease, cardiomyopathy, pericardial disease, aorta disease and vascular disease.

Coronary Artery Disease
Coronary artery disease is atherosclerosis of the coronary arteries. Atherosclerosis occurs when the arteries become clogged and narrowed, and this can restrict blood flow to the heart. Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly.

Heart Attack
A heart attack, or myocardial infarction (MI) is permanent damage to the heart muscle. "Myo" means muscle, "cardial" refers to the heart and "infarction" means death of tissue due to lack of blood supply. The heart muscle requires a constant supply of oxygen-rich blood to nourish it. The coronary arteries provide the heart with this critical blood supply. If you have heart disease, those arteries become narrow with plaque and blood cannot flow as well as it should. When the plaque's hard, outer shell cracks (plaque rupture), platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. If a blood clot totally blocks the artery, the heart muscle becomes "starved" for oxygen. Within a short time, death of heart muscle cells occurs, causing permanent damage. This is called a myocardial infarction (MI), or heart attack.

Metabolic Syndrome
Metabolic syndrome is a group of health problems that include too much fat around the waist, elevated blood pressure, high triglycerides, elevated blood sugar, and low HDL cholesterol. Together, this group of health problems increases your risk of heart attack, stroke, and diabetes. Metabolic syndrome is caused by an unhealthy lifestyle that includes eating too many calories, being inactive, and gaining weight, particularly around your waist.

Plaque
Atherosclerotic plaque is a waxy substance formed inside the arteries that supply blood to your heart. This substance, called plaque, is made of cholesterol, fatty compounds, calcium, and a blood-clotting material called fibrin. Doctors have found that there are two kinds of plaque: hard (calcified) and soft.

Most people know about hard plaque and how it can cause a heart attack. If hard plaque builds up in the arteries that supply blood to your heart, the blood flow slows or stops. This decreases the amount of oxygen that gets to the heart, which can lead to a heart attack.

But doctors have now found that even though some heart attacks are caused by hard plaque, most heart attacks are caused by soft or vulnerable plaque. A vulnerable plaque is an inflamed part of an artery that can burst. This can lead to the formation of a blood clot, which can lead to heart attack.

In fact, vulnerable plaque may be buried inside the artery wall and may not always bulge out and block the blood flow through the artery. This is why researchers began to look at how inflammation affects the arteries, and if inflammation could lead to a heart attack. What they found was that inflammation leads to the development of "soft" or vulnerable plaque. They also found that vulnerable plaque was more than just debris that clogs an artery, but that it contained different cell types that enhance blood clotting.

Patients with this kind of plaque may not feel symptoms. In the early stages of the process, the change in blood flow may not be detected with standard testing, but researchers are looking at special scanning techniques that may highlight the presence of vulnerable plaque.

Stroke
A stroke occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.

Brain damage can begin within minutes, so it is important to know the symptoms of stroke and act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.

Transient Ischemic Attack (TIA)
A TIA is a "warning stroke" or "mini-stroke" that produces stroke-like symptoms but no lasting damage. TIAs occur when a blood clot temporarily clogs an artery, and part of the brain doesn't get the blood it needs. The symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes. The average is about a minute. Unlike stroke, when a TIA is over, there's no injury to the brain. Recognizing and treating TIAs can reduce your risk of a major stroke.

Risk Factors

Cardiovascular Risk Factors
The major risk factors are well-established. A family history of heart disease is one risk factor. Other risk factors can be controlled. Of these, the main ones are high blood pressure, high cholesterol, diabetes, obesity, smoking, and a sedentary lifestyle. Stress is also believed to raise the risk, and exertion and excitement can act as triggers for an attack.

Men 45 and older and women 55 years and older are at increased risk of heart attack. High levels of estrogen are thought to protect premenopausal women fairly well from heart attack, but the risk increases significantly after menopause.

Cholesterol
Cholesterol is a waxy, fat-like substance made in the liver and found in certain foods, such as food from animals, like dairy products (whole milk and cheese), eggs and meat. The body needs some cholesterol in order to function properly. Its cell walls, or membranes, need cholesterol in order to produce hormones, vitamin D and the bile acids that help to digest fat. But the body needs only a small amount of cholesterol to meet its needs. When too much is present, health problems such as coronary heart disease may develop.

Low density lipoproteins (LDL): LDL, also called "bad" cholesterol, can cause buildup of plaque on the walls of arteries. The more LDL there is in the blood, the greater the risk of heart disease.
High density lipoproteins (HDL): HDL, also called "good" cholesterol, helps the body get rid of bad cholesterol in the blood. The higher the level of HDL cholesterol, the better. If your levels of HDL are low, your risk of heart disease increases.
Triglycerides: Triglycerides are another type of fat that is carried in the blood by very low density lipoproteins. Excess calories, alcohol or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.

Diabetes
About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke.

Diabetes is a disorder of metabolism--the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced (insulin resistance).

The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80 percent of people with type 2 diabetes are overweight.

Family History
Cardiovascular disease can run in families -- if you have a family history of heart disease, you may be at greater risk for heart attack, stroke, and other heart problems. The closer the relative, the greater your heart disease risk. If you have a "first-degree relative" -- that's a mother, father, sister, or brother (or even a son or daughter) who had heart disease at an early age (male relative younger than 55, female relative younger than 65), that increases your risk of developing heart disease. The more family members who have had early heart disease, the greater your risk of developing heart disease.

High Blood Pressure or Hypertension
Blood pressure is the force of blood pushing against blood vessel walls. The heart pumps blood into the arteries (blood vessels), which carry the blood throughout the body. High blood pressure, also called hypertension, is dangerous because it makes the heart work harder to pump blood to the body and it contributes to hardening of the arteries or atherosclerosis and the development of heart failure. There are several categories of blood pressure, including:

Normal: Less than 120/80
Prehypertension: 120-139/80-89
Stage 1 hypertension: 140-159/90-99
Stage 2 hypertension: 160 and above/100 and above

Smoking
About 30 percent of all deaths from heart disease in the U.S. are directly related to cigarette smoking. Smoking is a major cause of atherosclerosis. Among other things, the nicotine present in smoke causes:

Decreased oxygen to the heart.
Increased blood pressure and heart rate.
Decrease in the good HDL cholesterol.
Increase in blood clotting.
Damage to cells that line coronary arteries and other blood vessels, triggering atherosclerosis and heart disease.

Diagnostic Tests

Abdominal Ultrasound
An abdominal ultrasound uses reflected sound waves to produce a picture of the organs and other structures in the upper abdomen. It is often used to detect, measure, or monitor an aneurysm in the aorta. An aneurysm may cause a large, pulsing lump in the abdomen. No radiation is involved.

Carotid Ultrasound
The carotid arteries in the neck can be easily viewed with a risk-free ultrasound test. Atherosclerosis in these arteries suggests a higher risk for heart attacks and strokes. This is because atherosclerosis occurs throughout the body. The ultrasound helps doctors evaluate blood flow and can show blocked or reduced blood flow through narrowing in the major arteries of the neck. No radiation is involved.

CT Coronary Scan
Coronary computed tomography angiography (CTA) is a noninvasive heart imaging test currently undergoing rapid development and evaluation. High-resolution, three-dimensional pictures of the moving heart and great vessels are produced during a coronary CTA to determine if either fatty or calcium deposits (plaques) have built up in the coronary arteries.

Before the test, an iodine-containing contrast dye is injected into an IV in the patient's arm to improve the quality of the images. A medication that slows or stabilizes the patient's heart rate may also be given through the IV to improve the imaging results.During the test, which usually takes about 10 minutes, X-rays pass through the body and are picked up by special detectors in the scanner.

This kind of scan can also be used to study all parts of the body and is referred to as a whole body scan.

CT Cardiac Scan
Computed tomography, commonly known as a CT scan, combines multiple X-ray images with the aid of a computer to produce cross-sectional views of the body. Cardiac CT is a heart-imaging test that uses CT technology with or without intravenous (IV) contrast (dye) to visualize the heart anatomy, coronary circulation, and great vessels (which include the aorta, pulmonary veins, and arteries). From the CT cardiac scan a calcium score can be derived. That score is another useful indicator for determining risk.

Echocardiogram
An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen. Echo can be used as part of a stress test and with an electrocardiogram (EKG) to help your doctor learn more about your heart. No radiation is involved.

Stress Echo
During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine that makes your heart beat harder and faster. A stress echocardiogram is usually done to find out if you might have decreased blood flow to your heart. No radiation is involved.

Adapted from the WebMD, American Heart Association, Texas Heart Institute