Seth28 said:
Man you guys are in some serious denial, if you think you cant have a heart attack with a normal lipid profile and on low dosages of AAS you are dead wrong. could it be hyperlipidemia? could it be some smooth muscle hypertropy (the muscle in the coronary vessel wall) that narrowed the coronary vessels a bit, or maybe made them respond poorly to nitric oxide (vasodialator)? or an elevated LP(a)- a derivative of LDL that causes greater plaque formation than LDL itself? any mechanical problem (example an enlarged heart will equate to lower coronary perfusion pressures), or a host of genetic abnormalites?
Coronary Artery Disease is multifactoral and anabolic steroids increase the risk of a heart attack in many ways that are often immeasurable beforehand until too late. For example, steroids increase lipids, or create an infavorable HDL:LDL ratio, they increase Red blood cell production (this can create a situation where a narrowed artery in a normal person may not have a heart attack but in someone on steroids with a high RBC count will have one because they dont flow as well and stack up in the narrowed lumen. Steroids can cause an increase in heart size, this with NORMAL size coronary vessels can cause a decrease in blood flow to the heart.
HUHHHH! decrease in blood flow to the heart, with severe left ventricular hypertrophy you get ischemic changes to the inner endocardium b/c of the difficult perfusion, but AAS doesnt cause a cardiomyopathy of the LV unless predisposed or dramatic neglect of high blood pressure over an extended peroid, I agree with the caution but lets not scare people. There are ways to do AAS safely with lower doses and if worried about the RBC count then take a baby aspirin every day 81mg. LVH reverses itslef in most people when they quit the cycle, supposing people are normal in the first place.
As for the plaque rupture, it is a dramatic, often times unpredictable event-unfortunate for you , best wishes. Thats why the stress test wouldnt show it. Ill try to briefly explain the exam for others, obviously youll rapidly know alot about this yourself so this isnt necessarily for you.
1) The stress test is an important test to screen individuals who have risk factors or symptoms. They are not 100%.
2) Basic anatomy of the heart is that the heart is shaped like a football cut in half about the size of a fist, it sits anterior, inferior 60degrees to left, 30 degrees from the horizontal plane suspended by the base (great vessels), for the layperson- basically it sits to the left of chest and points down and to the left.
Over the top of the heart lies 3 coronary arteries that originate from the aorta (the major artery leaving the heart), these have several branches that feed the muscle of your heart. The heart after all is a muscular pump. There are two major concerns with the heart- like a house- the plumbing and the wiring. Plumbing causes heart attacks. The wiring causes heart rhythm disturbances- this obviously can kill you if the heart experience ventricular fibrillation. The plumbing can cause wiring problems, but usually not vice-versa, unless of course you have VFIB and no coordinated blood flow will reach the plumbing.
3) When people with risk factors, or chest pain talk to a doctor they are usually referred to cardiologist for a stress test. This is a screening test for plaque that has grown large enough to obstruct blood flow putting them at risk for a coronary artery to close off, thereby deprivng the muscle of the heart of nutrients- o2, but also very important is that the waste products are not carried away by the circulation and they build up as well. This process kills the muscle of the heart. A myocardial infarction. The plaque rupture increases this process, because once it ruptures your body sends clotting factors in the blood stream to that source, so a small plaque- that may have caused a problem years down the line if it had grown slowly, all of a sudden closes off.
4) A stress test (DAMN I HAVE TO EXPLAIN BRIEFLY AND LEAVE ALOT OUT) Basically recreates any symptoms or cardiac problems in a controlled environment. We have a crash cart and nitroglycerin and various life support medications ready for a problem.
3 basic types. The stress ekg, where a simple tracing of the electrical pattern of the heart is done while you walk(sometimes run in the later stages, but usually its the incline that gets people) on a treadmill. The electrical pattern of the heart will change across the section of heart that doesnt have blood flow, the Na/K ions dont function correctly. This is by far the most basic test used and is about 70% accurate b/c there are situations of false positives/negatives. SO, an imaging test is added to increase specificity. Either an echocardiogram or nuclear perfusion test. The echo uses ultrasound to visualize the heart muscle itself, you can actually confirm visually the heart muscle not moving. The nuclear test uses a radioactive tag, obviously if there is diminished blood flow to the heart, the tag will not be absorbed in certain sections of the heart muscle. Then a special camera takes a picture of the tag- it alomost looks like an infrared picture, the red is where more blood flow is, blacker if there is less. The nuc test is slightly superior, but is 3times as expensive and the stress echo is shorter and about 95%accurate. Careers have been made on which is a better test.
5) all of these tests pale in comparison to an angiogram (the gold standard) a very expensive test with a small risk and is only done if the above tests are positive or you are having a MI, or you have a damn good story- Like everytime I walk three blocks It feels like an elephant is sitting on my chest. LOL. This is where you go in and you are slightly unconsious. They insert a catheter into a major vessel, usually in the groin region, run it up to the heart and inject a dye directly into the coronary arteries. Then an xray is taken of this dye. This is not a common xray you see on tv. This xray lasts for some time like 7 seconds and is recorded like a movie of this dye filling the artery. You can see the narrowing of the artery, all of sudden you see the dye stop or the dye get real narrow.
6) The angiogram would have done nothing for your plaque rupture, if a plaque is large enough, we insert a small scaffolding called a stent, then blow it up and push the plaque out with a balloon. But if you had a 40% lesion, they wouldnt have done this b/c it can reocclude at a higher rate than if just left alone. Medical management would have been done aggresively though, but at least youre alive. And 15% reduction is not that bad, especially in the bottom of the heart. What is your ejectin fraction, do you know?
7) This leaves out a tremondous amount about structural abnormalities like mitral valve prolapse, aortic stenosis or other valvular issues, as well as diseases of the muscle etc, etc...but its wordy enough already.
Good Luck bro. AND lets all be safe by doing bloodwork and monitoring our blood pressure, dont use the store cuff either, most of you guys' arms are too big for them to be accurate(use a large cuff, go to a fire station- they should do it for free)
Please Scroll Down to See Forums Below 
