She came in as a new patient. She was about sixty years old, well-dressed, and fit. She was a nurse and she had had a heart attack about a month before. She was doing pretty well, but she was puzzled by her heart artery catheterization results a couple of weeks later that were completely normal. She had no blockages at all. She had not had a stent during the heart attack. “How could I have a heart attack with no artery blockages”
The answer is to be found in the image above of an intravascular ultrasound of a heart artery which is wide open. Men form more localized chronic blockages but women often distribute cholesterol along the artery more evenly so that it does not cause any obstruction. The green ring around the artery is a cholesterol deposit that extends throughout most of the artery. Multiple images through the length of this artery would show the same thing. Small areas of inflammation like a pimple form in those cholesterol deposits. When they burst open and the contents hit the blood it causes it to clot.
This is the most likely reason that this woman had a heart attack. She formed a clot that blocked the artery which broke up afterwards. That helps everyone understand the power of optimal medical therapy (OMT). OMT can even lead to reduction of those cholesterol deposits while reducing inflammation and stabilizing them so that they don’t rupture—no rupture, no clot, no heart attack! Check out the slide above. On the left side, without optimal medical therapy, cholesterol plaque ruptures and causes a blockage. On the right, OMT stabilizes and reduces the cholesterol deposit to make the artery more normal and prevent heart attack. In a patient like this who recently had a heart attack, OMT lowers the risk of dying by 90%. It helps women be healthier longer so that they can enjoy their children and grandchildren. Happy Mother’s Day!
Well, she could easily be exposed to small coronary artery disease invisible on an angiogram. Lifestyle optimization must be part of her treatment plan, since medical therapies often fail with patients living suboptimal lifestyle.
The imaging after my stroke showed no blockages, and I wonder if I had a situation similar to this woman. Cholesterol that was evenly distributed along the arteries.