Failed treadmill stress test...

Not a doctor, but:

- when was the angiogram done?
- can you provide more specific objective results (vs.
"clear"😉, for example, the % that each of your coronary
arteries are clear/blocked?

Larry

bigjon said:

A quick question for any the Medics in here.....

Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's in
2001, Angioplasty and 4 stents implanted. Since then
recurrent bouts of unstable Angina resulting in 14
hospitalizations, (Angiogram shows all clear) several goes
at Clot-busting drugs, but no more actual Mi's. Taking
Ramipril, Statins, Clopidogrel, Asprin, Diltiazem and
Nicorandel.

I failed my regular treadmill stress test (9-stage Bruce)
today. There were no noticeable changes to the ECG, nor
any unusual variations in BP. I just had a great deal of
pain (nearly passed out) and had to stop the test entering
stage 4. The technician was a little confused, thinking it
might be something other than Angina, and the Doctor had
very little to say to
me.

I guess this was exercise-induced angina, it certainly
felt like it, and GTN soon stopped the pain, but why were
there no other indicators ??

bigjon said:

A quick question for any the Medics in here.....

Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's in
2001, Angioplasty and 4 stents implanted. Since then
recurrent bouts of unstable Angina resulting in 14
hospitalizations, (Angiogram shows all clear)

(with past history of angioplasty and 4 stents, it be would
unexpected for your angiogram to be all clear)

Quoted message said:

several goes at Clot-busting drugs, but no more actual
Mi's. Taking Ramipril, Statins, Clopidogrel, Asprin,
Diltiazem and Nicorandel.

I failed my regular treadmill stress test (9-stage Bruce)
today. There were no noticeable changes to the ECG, nor
any unusual variations in BP. I just had a great deal of
pain (nearly passed out) and had to stop the test entering
stage 4. The technician was a little confused, thinking it
might be something other than Angina, and the Doctor had
very little to say to
me.

I guess this was exercise-induced angina, it certainly
felt like it, and GTN soon stopped the pain, but why were
there no other indicators ??

One possibility is that the culprit vessel is a tiny one
that supplies only a tiny amount of heart muscle that is too
small to either visualize with nuclear imaging or detect
with the EKG.

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

**
Who is the humblest person in the universe?
makeashorterlink.commakeashorterlink.comOpen ↗

What is all this about?
makeashorterlink.commakeashorterlink.comOpen ↗

Is this spam?
makeashorterlink.commakeashorterlink.comOpen ↗

Larry said :

Quoted message said:

Not a doctor, but:

- when was the angiogram done?
- can you provide more specific objective results (vs.
"clear"😉, for example, the % that each of your coronary
arteries are clear/blocked?

Larry

Not really - I am not treated by any one specific Doctor,
but rather a team at my local Hospital in the UK. The follow
up Angiogram was done roughly 6 months after the original
stenting to check that they had not failed, and they hadn't
- that's all I was told. It's a shame, but it's not until
after you get home and are feeling better do you think of
asking more in depth questions, and getting to see a
specialist on the NHS when it's not an emergency is almost
impossibe, especially if you simply want to ask
questions....

I just wonder why the intense pain I felt during the test
did not register on any of the equipment...

Dr. Andrew B. Chung, MD/PhD decided to share this with us :

Quoted message said:

bigjon said:

A quick question for any the Medics in here.....

Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's in
2001, Angioplasty and 4 stents implanted. Since then
recurrent bouts of unstable Angina resulting in 14
hospitalizations, (Angiogram shows all clear)

(with past history of angioplasty and 4 stents, it be
would unexpected for your angiogram to be all clear)

Quoted message said:

several goes at Clot-busting drugs, but no more actual
Mi's. Taking Ramipril, Statins, Clopidogrel, Asprin,
Diltiazem and Nicorandel.

I failed my regular treadmill stress test (9-stage Bruce)
today. There were no noticeable changes to the ECG, nor
any unusual variations in BP. I just had a great deal of
pain (nearly passed out) and had to stop the test
entering stage 4. The technician was a little confused,
thinking it might be something other than Angina, and the
Doctor had very little to say to
me.

I guess this was exercise-induced angina, it certainly
felt like it, and GTN soon stopped the pain, but why were
there no other indicators ??

One possibility is that the culprit vessel is a tiny one
that supplies only a tiny amount of heart muscle that is
too small to either visualize with nuclear imaging or
detect with the EKG.

Servant to the humblest person in the universe,

Andrew

So, you think that I could have experienced intense Angina
pain induced by the test, yet there are no visible signs on
the equipment? Is this something to worry about, or is it
minor enough to be dealt with by medication? Does a small
vessel blockage have the same MI risk as a major vessel
blockage? Could there be several of these small vessels
blocked, and if so, as there is no direct physical
treatment, will they deteriorate?

--
All truth passes through three stages: first, it is
ridiculed; next it is violently attacked; finally, it is
held to be self-evident....

I would call that hospital, and ask for a copy of the report
from the angiogram ... although since it was done some time
ago ... I don't know how valuable it would be. If it was
long enough ago, certainly things could have changed. And
I'm not so sure that it would be reflected in your ECG ...
although perhaps the Dr. can comment on this.

I would also ask the cardio who reviews your stress test
what he/she recommends at this juncture.

Larry

bigjon said:

Larry said :

Quoted message said:

Not a doctor, but:

- when was the angiogram done?
- can you provide more specific objective results (vs.
"clear"😉, for example, the % that each of your coronary
arteries are clear/blocked?

Larry

Not really - I am not treated by any one specific Doctor,
but rather a team at my local Hospital in the UK. The
follow up Angiogram was done roughly 6 months after the
original stenting to check that they had not failed, and
they hadn't - that's all I was told. It's a shame, but
it's not until after you get home and are feeling better
do you think of asking more in depth questions, and
getting to see a specialist on the NHS when it's not an
emergency is almost impossibe, especially if you simply
want to ask questions....

I just wonder why the intense pain I felt during the test
did not register on any of the equipment...

bigjon said:

Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's in
2001, Angioplasty and 4 stents implanted. Since then
recurrent bouts of unstable Angina resulting in 14
hospitalizations, (Angiogram shows all clear) several goes
at Clot-busting drugs, but no more actual Mi's. Taking
Ramipril, Statins, Clopidogrel, Asprin, Diltiazem and
Nicorandel.

I failed my regular treadmill stress test (9-stage Bruce)
today. There were no noticeable changes to the ECG, nor
any unusual variations in BP. I just had a great deal of
pain (nearly passed out) and had to stop the test entering
stage 4. The technician was a little confused, thinking it
might be something other than Angina, and the Doctor had
very little to say to
me.

I guess this was exercise-induced angina, it certainly
felt like it, and GTN soon stopped the pain, but why were
there no other indicators ??

1. You have had advanced coronary atherosclerosis, and most
likely diffuse, advanced peripheral atherosclerosis. The
cause may be lifestyle, genetic, or both. It is possible
that since 2001 you have successfully treated your
disease. However, relying on coronary angiograms and
treadmill tests as an indication of your treatment
success is dangerous.

2. You are expecting too much from your cardiovascular
tests; angiograms do not accurately asses cardiac
perfusion or coronary blood vessel flow dynamics.
Treadmill tests are inaccurate and overrated. Unstable
angina is the achilles heel of interventional cardiology;
80% of heart attacks arise from small, vulnerable plaques
that cannot be identified or treated by interventional
cardiology.

3. Stents and coronary bypass surgery have not been shown to
reliably improve long term outcomes for individuals
without heart failure before the procedure. The chances
of your stents having improved your outcome are probably
quite low. In fact, it is unlikely that your stents were
placed in the location that caused your heart attacks
anyway. However, the stents cannot be removed and you
must contend with them for the rest of your life by
taking medication you may not have needed otherwise.

4. You may have 'gut claudication' from peripheral
atherosclerosis. It can cause pain in the region of the
heart whilst the ECG remains normal. If you hopped on the
treadmill for the test looking for an answer but do not
routinely exercise, you set yourself up for failure.

5. If you 'guess' your pain is exercise-induced angina, then
you have been well trained by your interventional
cardiologist.

--
Winning against heart attack and stroke
sonoscore.comsonoscore.comOpen ↗

bigjon said:

Dr. Andrew B. Chung, MD/PhD decided to share this with
us :

Quoted message said:

bigjon said:

A quick question for any the Medics in here.....

Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's in
2001, Angioplasty and 4 stents implanted. Since then
recurrent bouts of unstable Angina resulting in 14
hospitalizations, (Angiogram shows all clear)

(with past history of angioplasty and 4 stents, it be
would unexpected for your angiogram to be all clear)

Quoted message said:

several goes at Clot-busting drugs, but no more actual
Mi's. Taking Ramipril, Statins, Clopidogrel, Asprin,
Diltiazem and Nicorandel.

I failed my regular treadmill stress test (9-stage
Bruce) today. There were no noticeable changes to the
ECG, nor any unusual variations in BP. I just had a
great deal of pain (nearly passed out) and had to stop
the test entering stage 4. The technician was a little
confused, thinking it might be something other than
Angina, and the Doctor had very little to say to
me.

I guess this was exercise-induced angina, it certainly
felt like it, and GTN soon stopped the pain, but why
were there no other indicators ??

One possibility is that the culprit vessel is a tiny one
that supplies only a tiny amount of heart muscle that is
too small to either visualize with nuclear imaging or
detect with the EKG.

Servant to the humblest person in the universe,

Andrew

So, you think that I could have experienced intense Angina
pain induced by the test, yet there are no visible signs
on the equipment?

Yes.

Quoted message said:

Is this something to worry about, or is it minor enough to
be dealt with by medication?

I would phrase it as follows:

"Your prognosis is likely good. There is nothing that can be
done in the way of interventions to relieve your symptoms.
However, medications and other measure to lower risk factors
will remain quite effective in preventing your next heart
attack and/or stroke."

Quoted message said:

Does a small vessel blockage have the same MI risk as a
major vessel blockage?

Yes.

Quoted message said:

Could there be several of these small vessels blocked, and
if so, as there is no direct physical treatment, will they
deteriorate?

With only "direct physical treatment" and no medical
treatment to lower coronary risk factors, they will
deteriorate.

Quoted message said:

--
All truth passes through three stages: first, it is
ridiculed; next it is violently attacked; finally, it is
held to be self-evident....

This reminds me of the 2PD approach :-)

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

**
Who is the humblest person in the universe?
makeashorterlink.commakeashorterlink.comOpen ↗

What is all this about?
makeashorterlink.commakeashorterlink.comOpen ↗

Is this spam?
makeashorterlink.commakeashorterlink.comOpen ↗

Larry decided to share this with us :

Quoted message said:

bigjon said:

Larry said :

Quoted message said:

Not a doctor, but:

- when was the angiogram done?
- can you provide more specific objective results (vs.
"clear"😉, for example, the % that each of your coronary
arteries are clear/blocked?

Larry

Not really - I am not treated by any one specific Doctor,
but rather a team at my local Hospital in the UK. The
follow up Angiogram was done roughly 6 months after the
original stenting to check that they had not failed, and
they hadn't - that's all I was told. It's a shame, but
it's not until after you get home and are feeling better
do you think of asking more in depth questions, and
getting to see a specialist on the NHS when it's not an
emergency is almost impossibe, especially if you simply
want to ask questions....

I just wonder why the intense pain I felt during the test
did not register on any of the equipment...

Quoted message said:

I would call that hospital, and ask for a copy of the
report from the angiogram ... although since it was done
some time ago ... I don't know how valuable it would be.
If it was long enough ago, certainly things could have
changed. And I'm not so sure that it would be reflected in
your ECG ... although perhaps the Dr. can comment on this.

I would also ask the cardio who reviews your stress test
what he/she recommends at this juncture.

Larry

I could ask for a copy of the Angiogram, but what would I do
with it ? I will ask what the cardiac docs think, I am due
to return to them in a few weeks for review...

Dr. Andrew B. Chung, MD/PhD decided to share this with us :

Quoted message said:

bigjon said:

Dr. Andrew B. Chung, MD/PhD decided to share this with
us :

Quoted message said:

bigjon wrote:
>
> A quick question for any the Medics in here.....
>
> Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's in
> 2001, Angioplasty and 4 stents implanted. Since then
> recurrent bouts of unstable Angina resulting in 14
> hospitalizations, (Angiogram shows all clear)

(with past history of angioplasty and 4 stents, it be
would unexpected for your angiogram to be all clear)

> several goes at Clot-busting drugs, but no more actual
> Mi's. Taking Ramipril, Statins, Clopidogrel, Asprin,
> Diltiazem and Nicorandel.
>
> I failed my regular treadmill stress test (9-stage
> Bruce) today. There were no noticeable changes to the
> ECG, nor any unusual variations in BP. I just had a
> great deal of pain (nearly passed out) and had to stop
> the test entering stage 4. The technician was a little
> confused, thinking it might be something other than
> Angina, and the Doctor had very little to say to
> me.
>
> I guess this was exercise-induced angina, it certainly
> felt like it, and GTN soon stopped the pain, but why
> were there no other indicators ??

One possibility is that the culprit vessel is a tiny one
that supplies only a tiny amount of heart muscle that is
too small to either visualize with nuclear imaging or
detect with the EKG.

Servant to the humblest person in the universe,

Andrew

So, you think that I could have experienced intense
Angina pain induced by the test, yet there are no visible
signs on the equipment?

Yes.

Quoted message said:

Is this something to worry about, or is it minor enough
to be dealt with by medication?

I would phrase it as follows:

"Your prognosis is likely good. There is nothing that can
be done in the way of interventions to relieve your
symptoms. However, medications and other measure to lower
risk factors will remain quite effective in preventing
your next heart attack and/or stroke."

Quoted message said:

Does a small vessel blockage have the same MI risk as a
major vessel blockage?

Yes.

Quoted message said:

Could there be several of these small vessels blocked,
and if so, as there is no direct physical treatment, will
they deteriorate?

With only "direct physical treatment" and no medical
treatment to lower coronary risk factors, they will
deteriorate.

Quoted message said:

Servant to the humblest person in the universe,

Andrew

Thank you.

Sonos decided to share this with us :

Quoted message said:

bigjon said:

Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's in
2001, Angioplasty and 4 stents implanted. Since then
recurrent bouts of unstable Angina resulting in 14
hospitalizations, (Angiogram shows all clear) several
goes at Clot-busting drugs, but no more actual Mi's.
Taking Ramipril, Statins, Clopidogrel, Asprin, Diltiazem
and Nicorandel.

I failed my regular treadmill stress test (9-stage Bruce)
today. There were no noticeable changes to the ECG, nor
any unusual variations in BP. I just had a great deal of
pain (nearly passed out) and had to stop the test
entering stage 4. The technician was a little confused,
thinking it might be something other than Angina, and the
Doctor had very little to say to
me.

I guess this was exercise-induced angina, it certainly
felt like it, and GTN soon stopped the pain, but why were
there no other indicators ??

1. You have had advanced coronary atherosclerosis, and
most likely diffuse, advanced peripheral
atherosclerosis. The cause may be lifestyle, genetic,
or both. It is possible that since 2001 you have
successfully treated your disease. However, relying on
coronary angiograms and treadmill tests as an
indication of your treatment success is dangerous.

2. You are expecting too much from your cardiovascular
tests; angiograms do not accurately asses cardiac
perfusion or coronary blood vessel flow dynamics.
Treadmill tests are inaccurate and overrated. Unstable
angina is the achilles heel of interventional
cardiology; 80% of heart attacks arise from small,
vulnerable plaques that cannot be identified or treated
by interventional cardiology.

3. Stents and coronary bypass surgery have not been shown
to reliably improve long term outcomes for individuals
without heart failure before the procedure. The chances
of your stents having improved your outcome are
probably quite low. In fact, it is unlikely that your
stents were placed in the location that caused your
heart attacks anyway. However, the stents cannot be
removed and you must contend with them for the rest of
your life by taking medication you may not have needed
otherwise.

4. You may have 'gut claudication' from peripheral
atherosclerosis. It can cause pain in the region of the
heart whilst the ECG remains normal. If you hopped on
the treadmill for the test looking for an answer but do
not routinely exercise, you set yourself up for
failure.

5. If you 'guess' your pain is exercise-induced angina,
then you have been well trained by your interventional
cardiologist.

Thank You.

You could gather the more objective information from the
angiogram report and post it to the group as a
clarification. "Clear" isn't exactly a precise medical
term. I'm sure someone like Dr. Chung could confirm
whether the angiogram demonstrated anything to be
concerned about or not.

Larry

bigjon said:

I could ask for a copy of the Angiogram, but what would I
do with it ? I will ask what the cardiac docs think, I am
due to return to them in a few weeks for review...

"Sonos" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

bigjon said:

Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's in
2001, Angioplasty and 4 stents implanted. Since then
recurrent bouts of unstable Angina resulting in 14
hospitalizations, (Angiogram shows all clear) several
goes at Clot-busting drugs, but no more actual Mi's.
Taking Ramipril, Statins, Clopidogrel, Asprin, Diltiazem
and Nicorandel.

I failed my regular treadmill stress test (9-stage
Bruce) today. There were no noticeable changes to the
ECG, nor any unusual variations in BP. I just had a
great deal of pain (nearly passed out) and had to stop
the test entering stage 4. The technician was a little
confused, thinking it might be something other than
Angina, and the Doctor had very little to say to
me.

I guess this was exercise-induced angina, it certainly
felt like it, and GTN soon stopped the pain, but why
were there no other indicators ??

1. You have had advanced coronary atherosclerosis, and
most likely diffuse, advanced peripheral
atherosclerosis. The cause may be lifestyle, genetic,
or both. It is possible that since 2001 you have
successfully treated your disease. However, relying on
coronary angiograms and treadmill tests as an
indication of your treatment success is dangerous.

2. You are expecting too much from your cardiovascular
tests; angiograms do not accurately asses cardiac
perfusion or coronary blood vessel flow dynamics.
Treadmill tests are inaccurate and overrated. Unstable
angina is the achilles heel of interventional
cardiology; 80% of heart attacks arise from small,
vulnerable plaques that cannot be identified or treated
by interventional cardiology.

3. Stents and coronary bypass surgery have not been shown
to reliably improve long term outcomes for individuals
without heart failure before the procedure. The chances
of your stents having improved your outcome are
probably quite low. In fact, it is unlikely that your
stents were placed in the location that caused your
heart attacks anyway. However, the stents cannot be
removed and you must contend with them for the rest of
your life by taking medication you may not have needed
otherwise.

4. You may have 'gut claudication' from peripheral
atherosclerosis. It can cause pain in the region of the
heart whilst the ECG remains normal. If you hopped on
the treadmill for the test looking for an answer but do
not routinely exercise, you set yourself up for
failure.

5. If you 'guess' your pain is exercise-induced angina,
then you have been well trained by your interventional
cardiologist.

Terrific info easily understood, Sonos. I've printed this
and hope I never have to refer to it.

B'adant

Zee said:

"Sonos" <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

bigjon said:

Briefly, 44yrs male, fit-ish, non smoker, had 3 Mi's
in 2001, Angioplasty and 4 stents implanted. Since
then recurrent bouts of unstable Angina resulting in
14 hospitalizations, (Angiogram shows all clear)
several goes at Clot-busting drugs, but no more actual
Mi's. Taking Ramipril, Statins, Clopidogrel, Asprin,
Diltiazem and Nicorandel.

I failed my regular treadmill stress test (9-stage
Bruce) today. There were no noticeable changes to the
ECG, nor any unusual variations in BP. I just had a
great deal of pain (nearly passed out) and had to stop
the test entering stage 4. The technician was a little
confused, thinking it might be something other than
Angina, and the Doctor had very little to say to
me.

I guess this was exercise-induced angina, it certainly
felt like it, and GTN soon stopped the pain, but why
were there no other indicators ??

1. You have had advanced coronary atherosclerosis, and
most likely diffuse, advanced peripheral
atherosclerosis. The cause may be lifestyle, genetic,
or both. It is possible that since 2001 you have
successfully treated your disease. However, relying
on coronary angiograms and treadmill tests as an
indication of your treatment success is dangerous.

2. You are expecting too much from your cardiovascular
tests; angiograms do not accurately asses cardiac
perfusion or coronary blood vessel flow dynamics.
Treadmill tests are inaccurate and overrated.
Unstable angina is the achilles heel of
interventional cardiology; 80% of heart attacks arise
from small, vulnerable plaques that cannot be
identified or treated by interventional cardiology.

3. Stents and coronary bypass surgery have not been
shown to reliably improve long term outcomes for
individuals without heart failure before the
procedure. The chances of your stents having improved
your outcome are probably quite low. In fact, it is
unlikely that your stents were placed in the location
that caused your heart attacks anyway. However, the
stents cannot be removed and you must contend with
them for the rest of your life by taking medication
you may not have needed otherwise.

4. You may have 'gut claudication' from peripheral
atherosclerosis. It can cause pain in the region of
the heart whilst the ECG remains normal. If you
hopped on the treadmill for the test looking for an
answer but do not routinely exercise, you set
yourself up for failure.

5. If you 'guess' your pain is exercise-induced angina,
then you have been well trained by your
interventional cardiologist.

Terrific info easily understood, Sonos. I've printed this
and hope I never have to refer to it.

You would be well advised never to refer to it, even if you
think you need it.

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

**
Who is the humblest person in the universe?
makeashorterlink.commakeashorterlink.comOpen ↗

What is all this about?
makeashorterlink.commakeashorterlink.comOpen ↗

Is this spam?
makeashorterlink.commakeashorterlink.comOpen ↗

(Zee) said:

Terrific info easily understood, Sonos. I've printed this
and hope I never have to refer to it.

B'adant

Here are a few clinical discussions/references you might
also find helpful regarding the concepts I outlined in the
earlier post...

tinyurl.com3h42vOpen ↗

1: Gould KL, Taegtmeyer H. Myocardial ischemia,
fluorodeoxyglucose, and severity of coronary artery
stenosis: the complexities of metabolic remodeling in
hibernating myocardium. Circulation. 2004 Mar 30;109(12):e167-
70; author reply e167-70. No abstract available. PMID:
15051653 [PubMed - in process]

2: Gould KL, Carabello BA. Why angina in aortic stenosis
with normal coronary arteriograms? Circulation. 2003
Jul 1;107(25):3121-3. No abstract available. PMID:
12835405 [PubMed - indexed for MEDLINE]

3: Sdringola S, Nakagawa K, Nakagawa Y, Yusuf SW,
Boccalandro F, Mullani N, Haynie M, Hess MJ, Gould KL.
Combined intense lifestyle and pharmacologic lipid
treatment further reduce coronary events and myocardial
perfusion abnormalities compared with usual-care cholesterol-
lowering drugs in coronary artery disease. J Am Coll
Cardiol. 2003 Jan 15;41(2):263-72. PMID: 12535820
[PubMed - indexed for MEDLINE]

4: Gould KL. Quantitative assessment of diffuse coronary
artery disease using a three-dimensional reconstruction
method compared with intravascular ultrasound images.
Coron Artery Dis. 2002 May;13(3):199; author reply 199-
200. No abstract available. PMID: 12131025 [PubMed -
indexed for MEDLINE]

5: De Bruyne B, Hersbach F, Pijls NH, Bartunek J, Bech JW,
Heyndrickx GR, Gould KL, Wijns W. Abnormal epicardial
coronary resistance in patients with diffuse
atherosclerosis but "Normal" coronary angiography.
Circulation. 2001 Nov 13;104(20):2401-6. PMID: 11705815
[PubMed - indexed for MEDLINE]

6: Kuikka JT, Raitakari OT, Gould KL. Imaging of the
endothelial dysfunction in coronary atherosclerosis.
Eur J Nucl Med. 2001 Oct;28(10):1567-78. Epub 2001 May
16. PMID: 11685501 [PubMed - indexed for MEDLINE]

7: Nakagawa Y, Nakagawa K, Sdringola S, Mullani N, Gould
KL. A precise, three-dimensional atlas of myocardial
perfusion correlated with coronary arteriographic
anatomy. J Nucl Cardiol. 2001 Sep-Oct;8(5):580-90.
PMID: 11593223 [PubMed - indexed for MEDLINE]

8: Sdringola S, Patel D, Gould KL. High prevalence of
myocardial perfusion abnormalities on positron emission
tomography in asymptomatic persons with a parent or
sibling with coronary artery disease. Circulation. 2001
Jan 30;103(4):496-501. PMID: 11157712 [PubMed - indexed
for MEDLINE]

9: Gould KL, Nakagawa Y, Nakagawa K, Sdringola S, Hess MJ,
Haynie M, Parker N, Mullani N, Kirkeeide R. Frequency
and clinical implications of fluid dynamically
significant diffuse coronary artery disease manifest as
graded, longitudinal, base-to-apex myocardial perfusion
abnormalities by noninvasive positron emission
tomography. Circulation. 2000 Apr 25;101(16):1931-9.
PMID: 10779459 [PubMed - indexed for MEDLINE]

10: De Bruyne B, Pijls NH, Heyndrickx GR, Hodeige D,
Kirkeeide R, Gould KL.

Pressure-derived fractional flow reserve to assess serial
epicardial stenoses: theoretical basis and animal
validation. Circulation. 2000 Apr 18;101(15):1840-7. PMID:
10769286 [PubMed - indexed for MEDLINE]

11: Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould
KL, Merritt TA, Sparler S, Armstrong WT, Ports TA,
Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle
changes for reversal of coronary heart disease. JAMA.
1998 Dec 16;280(23):2001-7. Erratum in: JAMA 1999 Apr
21;281(15):1380.

PMID: 9863851 [PubMed - indexed for MEDLINE]

12: Gould KL. Coronary arteriography and lipid
lowering: limitations, new concepts, and new
paradigms in cardiovascular medicine. Am J Cardiol.
1998 Sep 24;82(6A):12M-21M. Review. PMID: 9766343
[PubMed - indexed for MEDLINE]

13: Gould KL. New concepts and paradigms in cardiovascular
medicine: the noninvasive management of coronary artery
disease. Am J Med. 1998 Jun 22;104(6A):2S-17S. Review.
PMID: 9684847 [PubMed - indexed for MEDLINE]

14: Delgado R 3rd, Radovancevic B, Springer A, Gould KL,
Frazier OH. Improvement of reversible ischemia in
severe post-transplantation coronary artery disease.
Tex Heart Inst J. 1998;25(2):145-9. PMID: 9654661
[PubMed - indexed for MEDLINE]

15: Herd JA, Ballantyne CM, Farmer JA, Ferguson JJ 3rd,
Jones PH, West MS, Gould KL, Gotto AM Jr. Effects of
fluvastatin on coronary atherosclerosis in patients
with mild to moderate cholesterol elevations
(Lipoprotein and Coronary Atherosclerosis Study
[LCAS]). Am J Cardiol. 1997 Aug 1;80(3):278-86. PMID:
9264419 [PubMed - indexed for MEDLINE]

16: Gould KL. Why angina pectoris in aortic stenosis.
Circulation. 1997 Feb 18;95(4):790-2. Review. No
abstract available. PMID: 9054730 [PubMed - indexed
for MEDLINE]

17: Yoshida K, Mullani N, Gould KL. Coronary flow and flow
reserve by PET simplified for clinical applications
using rubidium-82 or nitrogen-13-ammonia. J Nucl Med.
1996 Oct;37(10):1701-12. PMID: 8862316 [PubMed -
indexed for MEDLINE]

18: Smith SC Jr, Blair SN, Criqui MH, Fletcher GF, Fuster
V, Gersh BJ, Gotto AM, Gould KL, Greenland P, Grundy
SM, Hill MN, Hlatky MA, Houston-Miller N, Krauss RM,
LaRosa J, Ockene IS, Oparil S, Pearson TA, Rapaport E,
Starke RD.

Preventing heart attack and death in patients with coronary
disease. Endorsed by the board of trustees of the American
College of Cardiology. Cardiovasc Nurs. 1996 Jul-Aug;32(4):26-
8. Review. No abstract available. PMID: 8846481 [PubMed -
indexed for MEDLINE]

19: Gould KL. Myocardial perfusion after cholesterol
lowering. J Atheroscler Thromb. 1996;3(2):59-61.
Review. No abstract available. PMID: 9226456 [PubMed -
indexed for MEDLINE]

20: Gould KL, Ornish D, Scherwitz L, Brown S, Edens RP,
Hess MJ, Mullani N, Bolomey L, Dobbs F, Armstrong WT,
et al. Changes in myocardial perfusion abnormalities by
positron emission tomography after long-term, intense
risk factor modification. JAMA. 1995 Sep 20;274(11):894-
901. PMID: 7674504 [PubMed - indexed for MEDLINE]

--
Winning against heart attack and stroke
sonoscore.comsonoscore.comOpen ↗

Sonos said:

(Zee) said:

Terrific info easily understood, Sonos. I've printed
this and hope I never have to refer to it.

B'adant

Here are a few clinical discussions/references you might
also find helpful regarding the concepts I outlined in the
earlier post...

tinyurl.com3h42vOpen ↗

1: Gould KL, Taegtmeyer H. Myocardial ischemia,
fluorodeoxyglucose, and severity of coronary artery
stenosis: the complexities of metabolic remodeling in
hibernating myocardium. Circulation. 2004 Mar 30;109(12):e167-
70; author reply e167-70. No abstract available.
PMID: 15051653 [PubMed - in process]

2: Gould KL, Carabello BA. Why angina in aortic stenosis
with normal coronary arteriograms? Circulation. 2003
Jul 1;107(25):3121-3. No abstract available. PMID:
12835405 [PubMed - indexed for MEDLINE]

3: Sdringola S, Nakagawa K, Nakagawa Y, Yusuf SW,
Boccalandro F, Mullani N, Haynie M, Hess MJ, Gould
KL. Combined intense lifestyle and pharmacologic
lipid treatment further reduce coronary events and
myocardial perfusion abnormalities compared with usual-
care cholesterol-lowering drugs in coronary artery
disease. J Am Coll Cardiol. 2003 Jan 15;41(2):263-72.
PMID: 12535820 [PubMed - indexed for MEDLINE]

4: Gould KL. Quantitative assessment of diffuse coronary
artery disease using a three-dimensional
reconstruction method compared with intravascular
ultrasound images. Coron Artery Dis. 2002
May;13(3):199; author reply 199-200. No abstract
available. PMID: 12131025 [PubMed - indexed for
MEDLINE]

5: De Bruyne B, Hersbach F, Pijls NH, Bartunek J, Bech
JW, Heyndrickx GR, Gould KL, Wijns W. Abnormal
epicardial coronary resistance in patients with
diffuse atherosclerosis but "Normal" coronary
angiography. Circulation. 2001 Nov 13;104(20):2401-6.
PMID: 11705815 [PubMed - indexed for MEDLINE]

6: Kuikka JT, Raitakari OT, Gould KL. Imaging of the
endothelial dysfunction in coronary atherosclerosis.
Eur J Nucl Med. 2001 Oct;28(10):1567-78. Epub 2001
May 16. PMID: 11685501 [PubMed - indexed for MEDLINE]

7: Nakagawa Y, Nakagawa K, Sdringola S, Mullani N, Gould
KL. A precise, three-dimensional atlas of myocardial
perfusion correlated with coronary arteriographic
anatomy. J Nucl Cardiol. 2001 Sep-Oct;8(5):580-90.
PMID: 11593223 [PubMed - indexed for MEDLINE]

8: Sdringola S, Patel D, Gould KL. High prevalence of
myocardial perfusion abnormalities on positron
emission tomography in asymptomatic persons with a
parent or sibling with coronary artery disease.
Circulation. 2001 Jan 30;103(4):496-501. PMID:
11157712 [PubMed - indexed for MEDLINE]

9: Gould KL, Nakagawa Y, Nakagawa K, Sdringola S, Hess
MJ, Haynie M, Parker N, Mullani N, Kirkeeide R.
Frequency and clinical implications of fluid
dynamically significant diffuse coronary artery
disease manifest as graded, longitudinal, base-to-
apex myocardial perfusion abnormalities by
noninvasive positron emission tomography.
Circulation. 2000 Apr 25;101(16):1931-9. PMID:
10779459 [PubMed - indexed for MEDLINE]

10: De Bruyne B, Pijls NH, Heyndrickx GR, Hodeige D,
Kirkeeide R, Gould KL.

Pressure-derived fractional flow reserve to assess serial
epicardial stenoses: theoretical basis and animal
validation. Circulation. 2000 Apr 18;101(15):1840-7.
PMID: 10769286 [PubMed - indexed for MEDLINE]

11: Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould
KL, Merritt TA, Sparler S, Armstrong WT, Ports TA,
Kirkeeide RL, Hogeboom C, Brand RJ. Intensive
lifestyle changes for reversal of coronary heart
disease. JAMA. 1998 Dec 16;280(23):2001-7. Erratum
in: JAMA 1999 Apr 21;281(15):1380.

PMID: 9863851 [PubMed - indexed for MEDLINE]

12: Gould KL. Coronary arteriography and lipid lowering:
limitations, new concepts, and new paradigms in
cardiovascular medicine. Am J Cardiol. 1998 Sep 24;82(6A):12M-
21M. Review. PMID: 9766343 [PubMed - indexed for
MEDLINE]

13: Gould KL. New concepts and paradigms in
cardiovascular medicine: the noninvasive management
of coronary artery disease. Am J Med. 1998 Jun 22;104(6A):2S-
17S. Review. PMID: 9684847 [PubMed - indexed for
MEDLINE]

14: Delgado R 3rd, Radovancevic B, Springer A, Gould KL,
Frazier OH. Improvement of reversible ischemia in
severe post-transplantation coronary artery disease.
Tex Heart Inst J. 1998;25(2):145-9. PMID: 9654661
[PubMed - indexed for MEDLINE]

15: Herd JA, Ballantyne CM, Farmer JA, Ferguson JJ 3rd,
Jones PH, West MS, Gould KL, Gotto AM Jr. Effects of
fluvastatin on coronary atherosclerosis in patients
with mild to moderate cholesterol elevations
(Lipoprotein and Coronary Atherosclerosis Study
[LCAS]). Am J Cardiol. 1997 Aug 1;80(3):278-86. PMID:
9264419 [PubMed - indexed for MEDLINE]

16: Gould KL. Why angina pectoris in aortic stenosis.
Circulation. 1997 Feb 18;95(4):790-2. Review. No
abstract available. PMID: 9054730 [PubMed - indexed
for MEDLINE]

17: Yoshida K, Mullani N, Gould KL. Coronary flow and
flow reserve by PET simplified for clinical
applications using rubidium-82 or nitrogen-13-
ammonia. J Nucl Med. 1996 Oct;37(10):1701-12. PMID:
8862316 [PubMed - indexed for MEDLINE]

18: Smith SC Jr, Blair SN, Criqui MH, Fletcher GF, Fuster
V, Gersh BJ, Gotto AM, Gould KL, Greenland P, Grundy
SM, Hill MN, Hlatky MA, Houston-Miller N, Krauss RM,
LaRosa J, Ockene IS, Oparil S, Pearson TA, Rapaport
E, Starke RD.

Preventing heart attack and death in patients with
coronary disease. Endorsed by the board of trustees of
the American College of Cardiology. Cardiovasc Nurs. 1996
Jul-Aug;32(4):26-8. Review. No abstract available. PMID:
8846481 [PubMed - indexed for MEDLINE]

19: Gould KL. Myocardial perfusion after cholesterol
lowering. J Atheroscler Thromb. 1996;3(2):59-61.
Review. No abstract available. PMID: 9226456 [PubMed
- indexed for MEDLINE]

20: Gould KL, Ornish D, Scherwitz L, Brown S, Edens RP,
Hess MJ, Mullani N, Bolomey L, Dobbs F, Armstrong WT,
et al. Changes in myocardial perfusion abnormalities
by positron emission tomography after long-term,
intense risk factor modification. JAMA. 1995 Sep 20;274(11):894-
901. PMID: 7674504 [PubMed - indexed for MEDLINE]

Wonder why your references are all one-sided (nearly all
have Gould as an author).

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

**
Who is the humblest person in the universe?
makeashorterlink.commakeashorterlink.comOpen ↗

What is all this about?
makeashorterlink.commakeashorterlink.comOpen ↗

Is this spam?
makeashorterlink.commakeashorterlink.comOpen ↗

MD/PhD said:

Sonos said:

(Zee) said:

Terrific info easily understood, Sonos. I've printed
this and hope I never have to refer to it.

B'adant

Here are a few clinical discussions/references you might
also find helpful regarding the concepts I outlined in
the earlier post...

tinyurl.com3h42vOpen ↗

references snipped

Quoted message said:

Wonder why your references are all one-sided (nearly all
have Gould as an author).

Servant to the humblest person in the universe,

Andrew

Might be a reason for B´adant and the rest of us interested
medical-laymen to search for additional references and
sources to keep us educated/informed about the subject.

Michael