Cardiovascular Evaluation
Heart attack and stroke are significant risks for most Americans
At the David Drew Clinic, we will strive with you, using the latest sophisticated assessment techniques, to minimize the likelihood of these potentially devastating events.
Cardiovascular disease is the number one killer of Americans. More than one million will suffer a heart attack this year. Of those, 30% will not survive the acute episode,
and 10% more will die during the next year. About 500,000 will suffer a stroke. Forty percent will be left with significant disability, and 30% will die within one year.
A major focus of the David Drew Clinic's heart attack and stroke prevention program is the detection and correction of cardiovascular disease before these destructive events occur.
Most often, heart attack and stroke are due to blockages of arteries that supply blood to the heart and brain. Excellent surgical and non-surgical methods to remove or bypass such
blockages have been developed. The key is to perform them before the damage is done.
Finding people with incipient heart attack or stroke is not simple. One quarter of heart attacks are silent, and an additional 25% occur without prior warning. Fully 80% of strokes
occur without warning symptoms. And both events occur frequently in persons with few or no known risk factors. Thus, the traditional approach of applying diagnostic tests only in
those with symptoms or with multiple risk factors often fails to anticipate heart attack and stroke. At David Drew, you and your personal physician will pursue a proactive plan to
identify significant structural heart disease or a pre-stroke condition, including:
Coronary CT scanning. To measure the build-up of plaque in the heart's arteries, many individuals will undergo computed tomography of the heart. This technique locates calcium in plaques and helps to determine how much coronary artery disease has already developed. The information is used to assist in managing the risk factors that accelerate plaque formation.
Heart imaging during stress. Even if you are symptom-free, you will periodically undergo a cardiac stress evaluation. Under stress, significant partial artery blockage can limit blood flow, resulting in abnormal function, even though symptoms may not occur. This principle is used in the conventional treadmill test, in which changes in the heart's electrical pattern are sought. As part of the David Drew program, your stress test will also include imaging of the heart, before and after stress. Imaging allows us to see changes in the function of the heart's muscle in response to stress, which can signal significant coronary disease and can help to assess the magnitude of the problem. This approach is considerably more sensitive than traditional treadmill methods.
Carotid artery imaging. Ultrasonography of the arteries leading to your brain will be performed to detect blockages. Blockages in the carotid neck arteries account for over 60% of strokes. Reduced flow in these vessels can be seen well before stroke occurs.
Cardiac ultrasonography. Periodic imaging of your heart by echocardiography will be done to look for structural abnormalities that can lead to heart malfunction and stroke. This procedure will detect abnormal thickening of the heart wall that sometimes leads to sudden death during athletics. It can also detect clots and other heart defects that may lead to stroke. About 20% of strokes are caused by clots released from the heart.
Fortunately, the number of heart attacks and strokes has declined over the past 20 years and has now leveled off, the result of risk reduction. Most promising is the fact that new interventions can greatly reduce the catastrophic outcomes of cardiovascular disease, if they are applied early enough.
At David Drew, we aggressively pursue the reduction of cardiovascular risks, especially in those patients who are at higher than average susceptibility. Your personal physician will work with you to identify your risk factors for cardiovascular disease, and will act effectively to minimize them.
Prevention modalities include:
Cholesterol management. Blood lipid measurements (including cholesterol) are made frequently. Nutritional, exercise and/or drug therapies may be prescribed by your physician to lower blood lipids, especially if your risk of cardiovascular disease is above average.
Stress assessment. Your physician and David Drew consultants will ascertain the amount of stress to which you are subjected and your response to it. The amount of time spent in pleasurable activities also will be established. If necessary, you and your physician may devise a plan to reduce the adverse effects of stress on your health.
Other risk modification. Other illnesses that increase the likelihood of cardiovascular disease, such as diabetes, will be aggressively prevented and/or treated. You will undergo evaluation for less common but serious silent diseases that may lead to sudden catastrophe, such as overactivity of the blood clotting system.
