FREQUENTLY ASKED QUESTIONS
What is noninvasive testing?
What is medical treatment of coronary artery disease?
What are the results of such medical treatment?
Is it necessary to do an angiogram in someone with no
symptoms but an abnormal stress test, or are there other tests that will provide the same
My cardiologist told me that because I had three blocked
coronary arteries on an angiogram I need immediate bypass surgery and there is no other
way to treat me. I have no symptoms and feel fine. Is this true?
Why, then, would a cardiologist make such a recommendation?
How can my coronary arteries be obstructed and yet I have no symptoms?
Are there any studies that compare angioplasty, bypass surgery and other
treatments such as chelation therapy with modern medical treatment with drugs?
Can coronary artery disease be cured or reversed?
Is chelation therapy effective?
I recently had an abnormal stress test. Because I have no
symptoms I refused angiograms. Now my cardiologist says medication will not help, and that
I can wait until I have symptoms. Is this true?
Question: What is noninvasive testing?
Answer: Noninvasive testing at the Noninvasive Heart Center involves
placing electronic sensors, pulse transducers, sonar devices, and
microphones on the chest. No catheters, tubes or needles enter or
"invade" the body. These tests image and permanently record
abnormalities of motion and function of the heart due to obstructive
coronary artery disease. Also, information about the heart's valves,
the dimensions of its chambers and the flow of blood within the heart
is imaged live. These tests are extremely sensitive in the early
detection of heart disease, and provide information about both
systolic and diastolic heart function,. The information derived
allows not only early discovery of disease, or its progression before
symptoms appear, but identifies patients with a high risk of future
heart attacks. It also makes possible the early detection of
complications, provides a more precise determination of cardiac
function and disability, and determines effectiveness and optimal
dosages of drugs used in treatment. Once heart disease Is found, then
predisposing conditions that accelerate its progression can be
identified, treated, and eliminated. Drugs which protect the heart
and improve its blood supply and function can then be given. The same
noninvasive tests used for early diagnosis may be utilized to monitor
the patient's progress. These can be compared with previous tests in
order to optimize treatment, and to detect and treat adverse changes
even before symptoms appear. Noninvasive tests avoid the need for
angiograms. Angiograms tell us about the coronary arteries, but not
very much about the heart's function. In contrast, noninvasive tests
picture the heart's anatomy, its function, and the blood flow through
its muscle and its chambers. Since prognosis and survival are related
more to the heart's function than to coronary narrowing, such data is
vital in deciding if a patient can be treated with drugs or surgery.
Bypass surgery and angioplasty are rarely needed. Modern drug therapy
combined with serial, noninvasive testing has revolutionized the
treatment of coronary artery disease. Such drugs are so effective
that an approaching heart attack often may be prevented entirely.
Also, other late complications such as heart failure usually can be
avoided. Thus, heart disease often becomes a relatively benign
illness with few or no symptoms and a normal life span.
Question: What is medical treatment of coronary artery disease?
Answer: When there is a reduction in blood flow to heart muscle due
to narrowed coronary arteries, it is like a reduction in income to a
business. When that happens the business has two options: one is to
find another source of income, and the second is to reduce expenses
to free up more money. In the case of the heart, there are drugs that
can increase the blood flow to the heart muscle, and there are other
drugs to reduce the expenses or work load of the heart. When properly
done, the "income" of the heart can be made to balance the "expenses"
of the heart. Now such a heart will not have symptoms, the
progression of the disease is greatly reduced, if not stopped
altogether, and the likelihood of such complications as a heart
attack, congestive heart failure, or premature death is vastly
reduced. Further information on what drugs are used can be found
elsewhere in this Web site.
Question: What are the results of such medical treatment?
Answer: As far as results are concerned, for my own patients with
primarily coronary artery disease and/or high blood pressure, 98-99%
of patients can be effectively treated with an adequate
individualized, medical program. Procedures such as angioplasty or
bypass surgery are almost never required. Not only does this result
in a saving of thousands of dollars, but it avoids the very common
post angioplasty, post bypass surgery complications that occur in up
to one-third of the patients who have these procedures. It also
avoids the high incidence of post operative heart attacks and
premature deaths that are seen in these patients. For example, the
combined death and heart attack rate in patients following
angioplasty/bypass surgery is about 7-8%/year vs. 1% on a tailored
medical program. Thus, in a five year period 35-40% of patients
undergoing angioplasty or bypass surgery can be expected to have a
major cardiovascular event. In contrast, in the patients I have been
following for the past 15 years, the five year cardiovascular event
rate has averaged only about 5% (1% / year). During that time, in a
practice limited to Cardiology, only 10 of my patients have had to
undergo angioplasty or coronary artery bypass surgery. I have never
lost a patient because he or she has NOT undergone bypass surgery or
angioplasty. Nor have any of them had a heart attack from NOT
undergoing one of these procedures. An exception would be patients
with severely damaged heart valves. Such patients eventually do
require surgery; however, effective medical treatment can often delay
the need for such surgery.
Question: I recently underwent a stress test. Even though I have no
symptoms, it was abnormal, and my primary care physician referred me
to a cardiologist. He spent only a few minutes with me and said I
needed an immediate angiogram. He said the angiogram was the only
test that would provide him with the information he needed to know,
that it was a routine x-ray of the heart and it was perfectly safe.
Are there other tests that can be performed? Is he telling me the
truth and is it as safe as he says?
Answer: He is not telling the truth. The angiogram, which is anything
but a routine x-ray of the heart, is usually safe when done by a
skilled cardiologist, but even in expert hands something can go
wrong. Each year over 13,000 patients in this country have a heart
attack, stroke or die during an angiogram. There are other, safer,
noninvasive tests that will provide a cardiologist with all the
information he needs to know. An angiogram is needed only when bypass
surgery or angioplasty is to be used to treat the patient. In other
words, your cardiologist has already made up his mind on how he
wishes to treat you, even though you have no symptoms. This is
contrary to accepted guidelines so presumably he is doing this for
self serving reasons.
Question: I'm 58 and have already had an angiogram because of an
abnormal electrocardiogram on a routine examination. I have been told
I have blockages in all three of my coronary arteries. One of those
blockages is 100%, the other two are 50% and 70%. Yet, I have no
symptoms, even though I'm very active, play singles tennis three
times a week, hike in the mountains, and have never had a heart
attack. The cardiologist says unless I undergo bypass surgery, those
arteries will close off and I could die. He say there is no other
treatment besides surgery. My father had bypass surgery and died a
few months later. I don't know what to do.
Answer: This is a common ploy of cardiologists and surgeons to lure
the patient into the operating room by using tactics I call medical
terrorism. No doctor can predict from an angiogram which artery will
close off, or indeed, whether any artery will close off. In addition,
he has no prior angiogram to compare with. Had an angiogram been done
on you 5 or even 10 years ago, it might have looked exactly the same.
The inference of the cardiologist that by undergoing bypass surgery a
future heart attack or death can be prevented is merely wishful
thinking. There are no modern studies that compare surgical treatment
or angioplasty with medical treatment of the Nineties. Indeed, quite
a number of recent studies have showed just the opposite. Not only is
aggressive medical treatment with surgery or angioplasty no better
than modern medical treatment, but patients undergoing such treatment
had much higher mortality rates.
Question: Why, then, would a cardiologist make such a recommendation?
Answer: There are many reasons. The kindest view is that the training
your cardiologist had was so narrow and focused that surgery or
angioplasty are the only ways he knows how to treat coronary artery
disease. Cardiologists also have quotas. They must perform at least
75 angiograms and angioplasties a year to maintain their hospital
privileges. If the cardiologist is employed by a hospital, the
hospital must perform several hundred heart procedures a year to
maintain their accreditation. Thus, his job may depend upon keeping
the operating room full.
Still another reason is that doing high tech procedures is very
profitable. Many hospitals would go out of business if it were not
for the surgeries that they do. Thus, if you have coronary artery
disease, and there is a choice on how you should be treated, guess
which choice is going to be made. There are still other reasons but
this gives you an idea why surgery is the preferred treatment for
coronary artery disease. It is not because it is the best treatment.
Question: How can my coronary arteries be obstructed and yet I have
Answer: An angiogram is a relatively primitive technology being over
40 years old. The resolution (smallest size that can be seen) is only
0.5 mm. That's only about the thickness of a piece of lead in a
mechanical lead pencil. Vessels smaller than 0.5 mm are invisible on
an angiogram. We call these vessels collateral vessels. Even if an
artery is completely obstructed, there may be a vast network of tiny,
collateral vessels through which blood can flow. In addition, an
adaptive response that occurs with blocked vessels is that upstream
from the blockage, new vessels will grow out from the artery and
reconnect to the obstructed artery downstream. This process is called
angiogenesis (angio= blood vessels and genesis= birth off). In a
sense, the heart puts in its own bypasses. Not unlike a freeway that
has been blocked off, traffic has to be rerouted but it still gets to
its destination---it merely takes a little longer, but the flow of
traffic is continuous. In the same way, if one or more coronary
arteries are blocked, blood is rerouted through the small collateral
vessels. These vessels cannot carry the quantity of blood that a
large artery can, so if the heart rate is too fast, or the blood
pressure too high, there may be a temporary reduction in blood flow
to the heart muscle. This may cause a stress test or radioactive
imaging test to be temporarily abnormal. That does not mean, however,
that the patient is at risk of a heart attack or of dying.
Question: Are there any studies that compare angioplasty, bypass
surgery and other treatments such as chelation therapy with modern
medical treatment with drugs?
Answer: There are no valid studies on angioplasty that document that
it is any more effective than placebo in the relief of symptoms. Nor
are there studies comparing angioplasty, or for that matter, bypass
surgery with modern medical treatment. These procedures are popular
for two reasons. The first and most important is that it make a great
deal of money for the cardiologist and surgeon who do them. Second,
bypass surgery does relieve symptoms, but only temporarily in 80% of
patients with chest pain. Neither procedure prevent heart attacks,
premature death, progression of the coronary artery disease, or late
complications such as congestive heart failure. The popularity of
these procedures have nothing to do with their therapeutic efficacy.
Question: Can coronary artery disease be cured or reversed?
Answer: You cannot cure coronary artery disease. Without adequate
medical treatment it will progress, develop long range complications
such as heart failure and ultimately result in death. Angioplasty,
bypass surgery and chelation therapy will not change that because
none of these treatments address the underlying results of the
disease, the factors that accelerate its progression, and the
complications of ischemia (reduction in blood flow to heart muscle.
On the other hand, modern medication, when given in sufficient
numbers, and in adequate amounts, will accomplish this goal. Sadly,
most patients with coronary artery disease never receive anywhere
near the proper number of drugs and/or in adequate dosage. Dozens of
studies have documented this. Programs such as the Ornish program
that claim to reverse heart disease are misleading. They do no such
thing. An adaptive response on the part of an obstructed artery is to
become larger in the vicinity of an obstruction. Thus, the
arteriosclerotic plaque appears smaller. But there is hope. While
coronary artery disease cannot be cured, it can be turned into a
benign illness compatible with a normal life span and with few if any
symptoms in most patients.
Question: Is chelation therapy effective?
Answer: The best that can be said for chelation therapy is that any
effectiveness in relieving chest pain is in the eyes of the beholder.
Testimony abounds about the relief of chest pain that occurs after a
series of treatments. The problem is that similar relief can be
obtained with prayer, meditation., acupuncture, angioplasty, coronary
artery bypass surgery and placebos. Given the heart's own ability to
revascularize itself, if it has enough time, the majority of patients
with angina will eventually get better---if they don't die first. If
you had chest pain, and undergo a series of treatments over a period
of months, and paid $4,000-$5,000.00, and your pain disappeared, you
would be convinced the chelation therapy did the trick. I wish it
were true. Unfortunately, there is no scientific evidence that this
treatment does what it claims. In itself, it may do no harm. Its
danger lies in the fact that effective treatment is delayed or does
not occur at all. If the patient is already on a medical program, the
doctor who pushed chelation therapy may recommend to the patient that
he or she can now discontinue their medications and this may have
disastrous results. The doctors who recommend this form of treatment
may be sincere, and may themselves have been duped by the false
claims and testimonies. While testimonies may be acceptable if you're
buying a car or a washing machine, it has no place in medicine for
treatment of a lethal disease.
Question: My cardiologist recently had me undergo a stress test and
it was abnormal: He now wants me to undergo angiograms and thinks I
may need angioplasty or bypass surgery. I have refused because I have
no symptoms. He now tells me I can wait until I have symptoms. This
doesn't sound right to me and he has not offered to put me on any
medication. Is this approach correct?
Answer: No, it is not. This is like locking the barn door after the
horse is stolen. Too many cardiologists only know how to treat
coronary artery disease with angioplasty or coronary artery bypass
surgery. The kinder view is that their training has been so narrow
and focused that they never learned how to treat coronary artery
disease with modern medication. An example of the consequences of not
treating silent coronary artery disease is congestive heart failure.
Instead of a major decline in the incidence of heart failure with
modern medications, congestive heart failure has now become the
number one discharge diagnosis from hospitals with an annual
incidence of 400,000 to 800,000/year depending upon who you read.
Proper medical treatment of coronary artery disease can prevent that
from happening as well as preventing future heart attacks and