Page 15 - Boca Club News - April '23

Boca Club News, Page 15
Medical Matters: Cardiovascular

Disease, Updated (Part Two)

By Richard Nagler, M.D., a member A high blood sugar level in diabetics activates pro- activated to reject it. This causes deterioration and necrosis
of Broken Sound Club and retired inflammatory chemicals in the blood. High levels of both at the base of the plaque and loosens its attachment, making
physician. After graduating from LDL cholesterol and triglycerides act as inflammatory it much more likely to rupture and completely obstruct the
the University of Pennsylvania agents themselves. Various viral diseases such as Flu, long artery, cutting off blood supply to heart muscle and resulting
and New York University’s School COVID and bacterial infections—for example, chronic in a heart attack.
of Medicine, Dr. Nagler served periodontal disease (gingivitis)—directly attack the inner Twenty percent of heart attacks present with sudden death.
his internship and residency at lining of the coronary arteries causing an inflammatory A person may suddenly keel over and literally be dead before
Baltimore City Hospital and Johns response. Collagen vascular diseases, such as rheumatoid hitting the ground, or discovered dead in bed by a spouse in
Hopkins. He followed that with a arthritis, lupus and periarteritis nodosa, have inflammatory the morning or just sitting in a chair. This is cardiac arrest,
Fellowship in Gastroenterology at Yale University School effects. So do some cancers. most often caused by ventricular fibrillation where the
of Medicine, and was then Chief of Gastroenterology at Once plaque has formed, it adheres to the inner lining heartbeat is extremely rapid and irregular and no blood is
Fitzimmons General Army Hospital in Denver. He returned of a coronary artery. It usually contains calcium, which being circulated. If defibrillation equipment is available it
to the Yale Medical School for one year as an Assistant can be evaluated by a measure of the calcium index by can be converted to a normal rhythm and a life saved.
Professor of Medicine before opening his own successful computerized technology. A score over 400 is suggestive of Although CPR is rarely successful, the attempt is
private practice in Internal Medicine and Gastroenterology. significant hard plaque formation but does not recognize the worthwhile even if just one life is saved. The second reason
During that time, he also served for ten years as Chief of more dangerous soft plaque. Hard plaque may stabilize and for sudden death is when the damage to the heart muscle is
Medicine at Huntington Hospital in Huntington, N.Y. remain unchanged and never cause a problem. It may slowly so massive that pump failure occurs, followed by cardiac
The dramatic reduction in deaths from heart attacks can build up in size and begin to obstruct blood flow through arrest where the heart simply stops beating. For the 75%
be attributed to the impressive technological advances in the the artery, but until the degree of obstruction reaches 70% who initially survive a heart attack, the eventual outcome
treatment of coronary artery disease where the inner lining there are no symptoms. depends on the degree of heart muscle damage, which is
of a coronary artery develops a build-up of plaque in one Beyond 70% the symptoms of angina appear described directly related to how quickly medical intervention is
or multiple areas. as a squeezing pressure in the center of the chest, usually applied to restore blood flow to the stricken area within
Plaque consists of fat, LDL cholesterol, triglycerides, radiating down the inner left arm, neck or jaw brought on a 90-minute time period. When a significant amount of
platelets, WBCs, thrombin, foam cells, collagen, fibrin and by physical exertion, and relieved by rest or a nitroglycerine the heart muscle cells are destroyed and replaced by scar
calcium. All of these elements in the blood pass through the tablet taken under the tongue. tissue, this will often be followed by the development of
coronary arteries with each contraction of the left ventricle The degree of obstruction can continue to progress and progressive congestive heart failure (CHF) that will result
of the heart, but in a normal coronary artery they do not increase to a 100% blockage resulting in a heart attack, but in death within two years.
adhere to the inner lining to form plaque. In order for plaque this is responsible for fewer than 10% of heart attacks. The (Next month: Part Three, the final installment in this
to form, inflammation in the inner lining of a coronary artery most common and dangerous development is the deposition series on Cardiovascular Disease.)
becomes a repository for the deposition of all these elements of a newer and more menacing softer form of plaque, which
to coalesce and form plaque. is less firmly attached to the inner lining of the coronary
There are several causative factors for inflammation to artery. It often appears as irregular contours in a coronary Your ad
occur. Nicotine is highly toxic and is a primary cause of artery as seen on an angiogram, but can be so small that it
inflammation; it also causes vasospasm, which narrows is found only at autopsy. It is rarely large enough to cause could be here!
the arteries and is implicated in angina. When the systolic significant obstruction or any symptoms, but is far more
blood pressure is high, the force of propulsion of blood from susceptible to rupture and be followed by the development Call
the contraction of the left ventricle of the heart produces a of a clot that can rapidly expand and completely obstruct
constant pounding effect against the wall of the coronary the vessel. This is responsible for 90% of all heart attacks. 561-746-3244
arteries, and this causes damage to the inner lining with The reason that plaque ruptures is that the body
secondary inflammation. recognizes it as a foreign body, and our immune system is
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