After no heart issues in the last 8 weeks it was time for my CT-Angiogram (Heart Scan with Contrast) as my cardiologist wanted to rule out blockages or other issues in the heart itself. With my Cholesterol being high by the standards most follow – even with great HDL and low Triglycerides and very low LPa – and a CAC score of 103 he wanted to rule out issues usually attributed to those things. In truth in looking at the CTA and what it can find I would say they should just skip a CAC if they are concerned – more on that when I talk about the results – but it is usually the case that to get a CTA covered by insurance you need a CAC over 100, high cholesterol and other factors – I guess thankfully I have those as it was covered. I did listen to a doctor talk about why Insurance does not like to pay for the CTA initially is that 40-60% of first heart attacks are fatal, I did look up some info and saw 30-50% but close, thus while a CTA might help if they do not do it they save as often it is after a heart attack when a CTA is approved. Bottom line if you are having issues a CAC test may be good but try and advocate for a CTA if you are concerned. The other reason I would push for a CTA is my CAC score during the CTA was 10 – a 90% decrease – and not sure if it is because a different and more precise machine, actual drop or some other reason. My initial guess is the CTA was more accurate. The issue is if you get a CAC above 100 most doctors go into the “standard of care’ process and Statins are prescribed among possible other medications. Again, this was just for info so you can ask the right questions.
A little info on a CTA as I had a scan with contrast for another issue a year or so ago and had no issue. For this one they warned me that there would be a bad taste in my mouth, might get a little headache and that I may feel like I wet myself. Did not have this when I did one before but sure did this time. Thankfully the test is quick as the bad taste made me a little nauseous and did get a little headache. As for the feeling of wetting myself - well that warm feeling sure did happen – thankfully they warned me. One thing the technicians were commenting on was that most people they deal with need medication to slow the heart down as it needs to be, I think I was told, under 60bpm. With my resting HR at low 40’s my cardiologist said I would not need them. Well, on the table during the test my HR was 43 and that helps with better pictures since the heart is not moving as much so the technician was happy and I was happy as did not need medication.
Here is the info from my CTA:
· The total calcium score is 10 indicating mild (CAC 1-100) calcified plaque in the coronary tree.
o Left main 0
o LAD 10 (Was 70 on first CAC)
o LCx 0 (Was 30 on first CAC)
o RCA 0
Grading Scale for Plaque Burden: Angiographic Findings:
· The coronary anatomy is left dominant.
o An interesting one as puts me in the minority at like 8%
o Also, can have implications with surgery as there is a higher have a higher risk of perioperative myocardial infarction during cardiac surgery
o So good to know this
· Left Main: No significant disease gives rise to LAD and circumflex
· LAD: Mild nonobstructive extraluminal plaque gives rise to 1 bifurcating diagonal
· LCX: Mild luminal irregularities dominant vessel posterior circulation gives rise to 4 obtuse marginal branches and PDA
· RCA: Small nondominant vessel posterior circulation with mid free wall bifurcation bifurcation
Noncoronary Cardiac Findings:
· Cardiac valves: Aortic valve is trileaflet. There is no thickening or calcification in the aortic and mitral valves.
· Pericardium: The pericardial contour is preserved with no effusion, thickening, or calcifications.
· Left ventricle: Calculated LVEF 67%
· Left atrial appendage: No thrombus
· Non-cardiac findings reported separately by radiology.
IMPRESSION:
· Minimal (1-24%) 1 vessel disease. CAD RADS 1
· Coronary calcium score 10
· No non-atherosclerotic coronary abnormalities
· LV systolic function (calculated LVEF 67%)
◦ A normal LVEF is typically between 50% and 70%.
◦ An LVEF of 67% is considered normal, indicating that the left ventricle is functioning well and effectively pumping oxygen-rich blood to the body.
◦ A LVEF of 67% suggests that the heart is in good condition and is not showing signs of heart failure.
The takeaway from all this, and the direction my cardiologist wants to go, is to just keep an eye on things and no need for medication. I will say I was pleased with my doctor on the initial consultation that while he talked about Statins – this was before my CTA and based on my blood test and CAC score of 103 – he did not push them and even commented that with me as an athlete I would not likely react well to them. I was very thankful for this as means that while he might have a Standard of Care protocol he also listens and understands my situation. Also, while there may be minimal plaque at 67 and not having always been one who ate well this shows my high Cholesterol which most would say puts me at great risk shows I am not as they would assume by simply looking at individual numbers. A big reason the things need to be looked at holistically and not mechanistically as the usual “Standard of Care” does.
I was told I can go back to training and I did ask if I can also ride, row or row, hard as I did before and was given the go ahead. But was told to keep an eye on things and continue to use my Frontier HRM and track with the ECG it creates my activities. From this I will continue as was starting to work at before and move to a more Polarized plan but likely at a 70/30 level till work back up to more time/miles as when under 10 hours the 80/20 is not the same. I need to be careful to not overdo it as I am pretty good at doing and know when to push and when to not. I may do a long ride in October and even then I need to do it for fun and not speed so as to simply enjoy the ability to take part. I need to realize that at the end of the day I ride, row and run because I enjoy it and need to do all I can to keep doing so. Will I race, probably but with an eye on my health and being ready to throttle back as need be.
The other areas I will be working on in the next 5 months is my sleep - as it has not been good for quite some time - and making sure I get enough electrolytes. If I have the begginings of AFIB finding the trigger is important. As far as sleeo I sleep well once I get to sleep but no matter when I go to bed I do not fall alspeep till between 1:30am - 2:30am. The problem there is I have to get up for work so hard to get in much more sleep. Just need to figure out how to fall alspeep sooner as do feel tired but just do not fall asleep quickly.
The other areas I will be working on in the next 5 months is my sleep - as it has not been good for quite some time - and making sure I get enough electrolytes. If I have the begginings of AFIB finding the trigger is important. As far as sleeo I sleep well once I get to sleep but no matter when I go to bed I do not fall alspeep till between 1:30am - 2:30am. The problem there is I have to get up for work so hard to get in much more sleep. Just need to figure out how to fall alspeep sooner as do feel tired but just do not fall asleep quickly.
I also need to make sure I get enough electrolytes in and the correct ones. The interesting part is knowing what is the right amount and while there are all sorts of tests they are really only as good as the time they were taken. I do know magnesium is important and was told to ask for a Magnesium RBC test during my next physical tells how much magnesium in the Red Blood Cells and a much better indicator of if there are issues. Bottom line AFIB can be triggered by dehydration or not enough electrolytes so will be wokring on that as well.
In all this as I move forward I need to, as Proverbs 16:3 says,
“Commit your works to Yahweh
And your plans will be established.”
Proverbs 16:3
to commit my plans to God and trust He will guide. Now while some may wonder how this can be and is it some sort of incantation theology. Well, it is not as to trust in God and is plans is to use wisdom, God granted wisdom, to seek out what needs to be done and trust God will reveal the path. While God can, and does still, perform miracles and divine leading more often than not HE simply uses means to reveal what needs to be done. This happens by reading, studying and discussing all I can on what I may be dealing with and seek wisdom in putting it all together in a manner that glorifies God and leads to what God has for me to do.
I will post more on this as things take place that relate to it. But may be longer between them but for sure will share more after my follow up visit in late January of 2027.
Past Posts in Series
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