Dr. Sagar Ramesh Makode
Cardiology
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Patient's Query
Hello doctor,
I am a 76-year-old woman, weigh 121 lbs, BMI 20. The examination results from annual wellness check-up are as follows. Coronary calcium scan: LMA 0 HU, LAD 185 HU, LCX 1 HU, RCA 90 HU, Total: 276 HU. Routine wellness EKG summary: aortic valve thickened and calcified. Normal mitral valve with mild mitral regurgitation. Mild cuspid regurgitation. Mildly increased PASP. Physiologic pulmonic regurgitation. Arterial doppler of legs: Normal flow and pulse. Medication: Only Irbesartan 150 mg. Without medicines, BP varies between 120/70 mmHg to 155/80 mmHg, is labile, so I take Irbesartan to stabilize it. With Irbesartan, it is nearly always 120/80 mmHg. Additional data: Former smoker for 19 years, quit before 24 years. Genetic data analysis suggests a high risk for CHD. Exercise: I began exercising 2 to 3 times weekly about six months ago. 60 to 100 minutes aerobic, weight training. On a treadmill, I try to keep my pulse to 90 % of maximum (target 130 %) but it reaches that in six minutes walking at 3.73 mph and it often goes to 135 % at which point I slow the walking speed to bring it back down. Recovery time to drop 12 bpm is 75 seconds. Question: Am I taking a risk of stroke by pushing myself beyond 130 bpm (90 %) even if only for a short time? Should I regularly see a cardiologist?
Hello,
Welcome to icliniq.com.
Firstly, answering your queries, you should visit a cardiologist regularly and avoid strenuous activities in order to reduce the risk of acute coronary syndrome. Your echocardiography has some abnormalities which are age-related and there is no evidence of CAD (coronary artery disease). However, calcium score is elevated which implies there is a significant risk of coronary artery disease, which is probably in earlier stages as you do not get any symptoms on the treadmill. However, such minor plaques may rupture and give rise to ACS (acute coronary syndrome). So, you should avoid strenuous activity and should be on both antiplatelet like Aspirin and statins. Also, you should undergo a stress test like either stress thallium or stress echo or treadmill test.
Patient's Query
Thank you doctor,
In my country, Aspirin is not advised for people over 65. But I will schedule a stress test. What exactly do you mean by strenuous?
Hi,
Welcome back to icliniq.com.
Okay. You may discuss with the local cardiologist for advisable antiplatelets. Also, till your evaluation is done, activities more than 30 to 40 minutes continuously, more than 90 percent of maximum heart rate should be avoided.
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Cardiology
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