Cardiology

Cardiac health: In great shape but close to death

"I was extremely lucky," says Frank – and it's not a visit to the casino that he's referring to. It’s a life-saving check-up.

5min

Andrea Lutz

Published on February 18, 2022

Frank is a businessman, father of two, and passionate endurance athlete. He says, "I feel like I’m 30." However, Frank's date of birth makes doctors sit up and take notice: 1969. Even if a 52-year-old patient seems to be extremely fit, it’s still worth taking a closer look.

Watch the video about Frank telling his story and how grateful he is that his friend pushed him to be screened.

When conducting check-ups, doctors first assess the common risk factors for certain diseases. Age, high blood pressure, high cholesterol, and smoking are typical risk factors for coronary artery disease. These factors together do make up a risk profile, but it’s one that doesn't necessarily exist in every person who suffers a heart attack. If these factors do not exist, high-risk patients may not be reliably detected.

No cause for concern

It is thanks to the insistence of a good friend that Frank (name changed) is alive today: "Go for a check-up," his friend warned, who had only recently himself undergone a cardiac catheterization. Frank dithered: “I felt full of energy. As far as I could tell, there was no cause for concern. I don’t smoke, I eat healthily, and I do a lot of sport. There’s no history of heart disease in my family.” Because Frank’s friend kept on at him, he finally made an appointment for a cardio check-up at the Cardiovascular Center Bethanien (CCB) in Frankfurt am Main.

Shocked by the findings

The CCB ordered basic tests including a stress electrocardiogram, an echocardiogram, and laboratory diagnostic tests. Stress ECG revealed nonspecific ST deviations of the inferior leads. Therefore, the physicians also ordered a coronary CT scan, which detected coronary calcium – a sign of coronary atherosclerosis. Additionally, a coronary CT angiogram (CCTA) was performed. The CCTA showed a 90% stenosis of the right coronary artery (RCA). The findings came as a shock to Frank. The clinical CT images showed calcification of the coronary arteries and a stenosis.

Inferior leads

The ECG registers 12 leads. Based on these, the electrical excitation in the heart is localized, but also deviations are detected.

A CCTA showing subtotal stenosis of the right coronary artery

A CCTA showing subtotal stenosis of the right coronary artery

“This was a huge shock, and according to the doctors had to act immediately," says Frank. He was transferred to the cath lab and the CT findings were confirmed by invasive coronary angiography. Frank underwent immediate successful coronary intervention with implantation of two stents. The procedure restored coronary blood flow to the myocardium. After an uneventful course, Frank was discharged just one day later. He wanted to get back to normal life as quickly as possible – and he did manage to return to his printing business 24 hours after the intestentrvention, just as if nothing had happened.

What is a stent?

A stent is a wire mesh made of synthetic fiber or metal. These vessel-supports are introduced to expand arteries and keep them open. This keeps blood flowing.

Nevertheless very lucky

"I really don't understand why I hadn't noticed the coronary arteries narrowing,” says Frank. Today, he suspects that what he thought was merely aching muscles after lifting weights could actually have been the painful signs of blocked coronary arteries. "But I didn't make the connection. When I saw the images of my narrowed arteries, I was speechless," he says. It all ended well, though. Testing for rare risk factors like lipoprotein A showed no pathologies. The patient obviously benefited from the fact that he is very active – but he was nevertheless very lucky. Now Frank is turning this luck to his advantage: "I’m on a follow-up program and have my other organs checked on a regular basis. I have more awareness for the subject and encourage my friends to go for a check-up. I feel lucky that I can now continue my healthy lifestyle and still do sports."

More information on coronary artery disease

Death rate from heart attack is on the decline
Coronary artery disease (CAD) is one of the cardiovascular diseases that are the leading cause of death globally, taking an estimated 17.9 million lives each year.¹Early detection during the symptom-free initial stages of cardiovascular disease, as in Frank's case, could prevent many deaths.² There is good news on this front: Although cardiovascular disease is still the main cause of death globally, the death rate from heart attack is on the decline.³ The main reasons given are advances in diagnosis and therapy. Moreover, the opportunities for innovation in cardiovascular medicine are by no means exhausted yet.

Know the signs
If you are having a heart attack, every second counts. Getting the right treatment fast can prevent serious consequences and even death. There are typical signs and symptoms of a heart attack – learn to recognize them and react quickly.

Typical signs and symptoms of a heart attack, most common for men and women

Information to take to heart

During diagnosis and therapy planning for coronary artery disease, patients and their relatives are confronted with many specialist terms. A few of them are explained briefly here.

: In many people, calcium forms in the coronary vessels over a lifetime. Coronary plaque leads to a narrowing of the vessels and thus to insufficient blood supply to the heart muscle. Calcium indicates the extent of coronary plaque formation – called atherosclerosis – and people with above-average levels of coronary calcium also have an increased risk of heart attack.⁴
Two options for coronary revascularization
Normal coronary blood flow can be restored by percutaneous coronary intervention with stent implantation (left) or by surgical bypass grafting (right).
: Atherosclerosis is a specific type of arteriosclerosis. It occurs when fats, cholesterol, and other substances build up in the walls of your arteries. This buildup is called plaque. Plaque can cause your arteries to narrow, blocking blood flow. It can also rupture, leading to a blood clot.

Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis can be treated and healthy lifestyle habits can help prevent it.
How can arteriosclerosis occur?
When arteries that carry oxygen and nutrients from the heart to the rest of your body become thick and stiff, restricting blood flow to organs and tissues.
Lifestyle choices to reduce CAD risk
Stop smoking
Eat healthily
Check your cholesterol level
Check your blood pressure
Exercise every day
Control your weight based on your BMI
Manage diabetes
Reduce stress
Limit alcohol consumption

Take care of yourself
A healthy lifestyle includes reducing stress and having regular medical check-ups. Staying active and eating a balanced diet will also benefit your body and your mind.
: If coronary artery disease is suspected but the patient has not suffered an acute heart attack, a coronary CT angiography (CCTA) can detect any narrowing of the vessels or occlusion using a noninvasive CT scan. The examination requires the administration of contrast agent, so that the interior of the vessels can be delineated from the vessel wall. The advantage of CCTA is that it can very accurately rule out vessel narrowing in cases where there is only low plaque buildup. It can also reliably detect extreme narrowing (also called stenoses). In these cases, an additional cardiac catheter examination is required.
: With the latest CT technology – photon-counting computed tomography [1] – it is now possible to diagnose even more patient groups, in particular those with very high calcification, more precisely than ever before. The system – NAEOTOM Alpha – can keep the acquisition time so short that the heart is visualized in the resting state between two beats, thereby producing a sharp image. An entirely new detector technology not only produces optimum image quality for reporting, but also measures the energy of each individual X-ray photon so that the calcium content in the blood vessel can be registered and removed virtually during postprocessing in order to visualize the actual blood vessel. As a result, the extent of the narrowing in the coronary arteries can be reliably assessed from the CT scan.

Discover more

Coronary artery disease

By Andrea Lutz

Andrea Lutz is a journalist and business trainer specialized on medical topics, technology, and healthcare IT. She lives in Nuremberg, Germany.

© Video: Rabbitz

1 https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1, January 2022.

2 Deutsche Herzstiftung (ed.). Deutscher Herzbericht 2020. Frankfurt am Main, June 2021.

3 https://dzhk.de/aktuelles/news/artikel/schutz-vor-dem-herzinfarkt-herzstiftung-unterstuetzt-verbesserung-der-frueherkennung

4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056023/

[1] The products/features (mentioned herein) are not commercially available in all countries. Their future availability cannot be guaranteed.

[2] The statements by Siemens Healthineers customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.