Plaque and Heart

[carlyai]

Evidently plaque can build up on the inside and the outside of the coronary arteries.  

If you have plaque build up on the outside of the artery only, what is the treatment?

[Sheryl]

Plaque by definition means build of of athersclerosis inside the artery.

There is no such thing as plaque on the outside of an artery.

 

There are different types and extent of plaque but they are all located on the inside wall of the artery.

[carlyai]

13 minutes ago, Sheryl said:

Plaque by definition means build of of athersclerosis inside the artery.

There is no such thing as plaque on the outside of an artery.

 

There are different types and extent of plaque but they are all located on the inside wall of the artery.

Well sorry to differ from your opinion, but I had a Calcium score test and was 445 so recommended to a cardiologist. Did CT scan before and after treadmill. All fine while exercising but after exercise recovering I developed an extra beat for a time. So going for an angiogram, but the specialist said we can't tell exactly with me as a boarder line case if the plaque is inside or outside the coronary arterial wall. Also showed me a model of plaque inside and outside of artery.

Said if it's inside then you may need a stent.

First time I've heard of plaque outside the artery wall and only one reference i can find where it said no stent but quarterization, so thought I'd ask here. ????

[Sheryl]

3 minutes ago, carlyai said:

Well sorry to differ from your opinion, but I had a Calcium score test and was 445 so recommended to a cardiologist. Did CT scan before and after treadmill. All fine while exercising but after exercise recovering I developed an extra beat for a time. So going for an angiogram, but the specialist said we can't tell exactly with me as a boarder line case if the plaque is inside or outside the coronary arterial wall. Also showed me a model of plaque inside and outside of artery.

Said if it's inside then you may need a stent.

First time I've heard of plaque outside the artery wall and only one reference i can find where it said no stent but quarterization, so thought I'd ask here. ????

Are you sure you understood him correctly and that he was not referring to which layer if the artery lining was involved?

[carlyai]

5 hours ago, Sheryl said:

Are you sure you understood him correctly and that he was not referring to which layer if the artery lining was involved?

I thought I understood him correctly, but could be wrong. He showed me 2 models of plaque build up. 1 was the standard model of plaque build up inside the wall of the artery, the other model was plaque build up on the wall of the artery but not inside the artery but outside the artery. 

One requires a stent if deemed necessary, the other not. 

One model showed the plaque blocking the artery, the other model showed the plaque on the outside of the wall bulging out and therefore not blocking the artery.

 

[carlyai]

 One of the only references I've found.

Would be nice if this was the same for me, but having an extra beat for a short while after a stress test but not during it is a worry.

Strange (to me that is) I can walk up hills and flights of stairs with no trouble while I'm doing it.

'What does it mean when plaque is outside the artery?

a_lake Sep 23, 2011

I just had a cardiac catheterization done. No major blockage, so no stent, just a catheterization.  The Dr. said there was plaque buildup on the outside of the artery, which causes it to bulge out, rather than the typical plaque buildup narrowing the artery.  Just had this done three days ago, and of course I was kind of fuzzy when he was explaining this.'

[Sheryl]

As I have explained there is no such thing as plaque outside the artery. I think this poster misinterpreted something just as you did.  Possibly to do with which layer of the artery lining was affected.

[Sheryl]

Specificlly, there are 2 types depending in the layer of the artery wall involved:

 

Two recognized types of CAC are intimal or superficial and medial artery calcification. Atherosclerotic calcification mainly occurs in the intima.^[9] Inflammatory mediators and elevated lipid content within atherosclerotic lesions induce osteogenic differentiation of vascular smooth muscle cells (VSMC).^[10] Conversely, CAC in the media is associated with advanced age, diabetes, and CKD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712374/

 

Both intimal and medial calcification occur inside the artery, but medial calcification is further from the inside (intimal is the innermost lining). It is not, however, benign.

 

 

[carlyai]

Ok, lets say I  have plaque in the artery. 

Some plaque can grow to block the artery and some can grow out from the artery therefore not narrowing or blocking it.

Is this correct?

[Sheryl]

57 minutes ago, carlyai said:

Ok, lets say I  have plaque in the artery. 

Some plaque can grow to block the artery and some can grow out from the artery therefore not narrowing or blocking it.

Is this correct?

 

No, nothing "grows out" from the artery and there is no way it could without breaking the wall of the artery which would lead to immediate death. An arterial wall can however bulge; that is called an aneurysm and it is dangerous as it can rupture.  Possibly when doctors have spoken of a "bulge" in an artery that is what they referred to.

 

The type of calcifications that occur in the intima (innermost layer of the artery lining) tend to be the type of plaque you are thinking of and these can block the artery.  Calcifications that  occur in the media (a more outer layer of the inside of the artery, but still the inside of the artery) tend to be arteriosclerotic but not atherosclerotic i.e. they create stiffening ("hardening") of the artery but do not block the artery per se.  However, this stiffening  also has negative consequences for cardiac health as the stiffened arteries have difficulty meeting the heart muscle's blood supply needs especially in times when such need is increased. And it is a string risk factrp for the development of aneurysms (see above).

 

In addition if medial calcification is present in the coronary arteries it will also often be present elsewhere in the body where it can likewise have negative consequences (e.g. compromised kidney function).

 

It would be unusual to have medial calcification of the coronary artery without some amount of concomitant calcification/atherosclerosis of the intima.

 

Coronary angiogram is needed in a case such as yours to determine whether there is any blockage of  the arteries and if so, how much.

[carlyai]

12 hours ago, Sheryl said:

 

No, nothing "grows out" from the artery and there is no way it could without breaking the wall of the artery which would lead to immediate death. An arterial wall can however bulge; that is called an aneurysm and it is dangerous as it can rupture.  Possibly when doctors have spoken of a "bulge" in an artery that is what they referred to.

 

The type of calcifications that occur in the intima (innermost layer of the artery lining) tend to be the type of plaque you are thinking of and these can block the artery.  Calcifications that  occur in the media (a more outer layer of the inside of the artery, but still the inside of the artery) tend to be arteriosclerotic but not atherosclerotic i.e. they create stiffening ("hardening") of the artery but do not block the artery per se.  However, this stiffening  also has negative consequences for cardiac health as the stiffened arteries have difficulty meeting the heart muscle's blood supply needs especially in times when such need is increased. And it is a string risk factrp for the development of aneurysms (see above).

 

In addition if medial calcification is present in the coronary arteries it will also often be present elsewhere in the body where it can likewise have negative consequences (e.g. compromised kidney function).

 

It would be unusual to have medial calcification of the coronary artery without some amount of concomitant calcification/atherosclerosis of the intima.

 

Coronary angiogram is needed in a case such as yours to determine whether there is any blockage of  the arteries and if so, how much.

Hi Sheryl, yes I am having an Antingham on the 8th of next month.

So this was what I have done: 1. I requested a calcium score test to check on plaque in my heart arteries. The test showed plaque build up mainly in one artery. Did a stress test on a treadmill and they found an extra heart beat for about 5 mins. on recovery. Saw cardiologist and he said we are sitting on the fence as not sure the plaque is blocking the artery or on the outside growing out. He said if the plaque is on the inside he will insert a stent.

So that is where I'm up to. 

I'll ask him more on the 8th and report back.

It seems strange to me,  that on the treadmill, raising my heart rate to (85% max or what ever it was they wanted), would increase my blood flow, and if I had a blockage i thought i should have felt it then, not on recovery.

Anyway I'm not a dr. And don't know. ???? Will soon but...

[meechai]

Maybe doctor meant this?
 

Quote

 

Researchers have confirmed that fat surrounding the outside of arteries in humans

-- particularly the left coronary artery -- may influence the onset of coronary artery disease,

or atherosclerosis, which is the leading cause of death in the US.

 

Fat outside of arteries may influence onset of coronary artery disease

[pseudorabies]

I think the OP might be referring to plaque progression into the sub-endothelial space (space between the endothelium and the smooth muscle wall of the artery) which is a more advanced stage of atherosclerosis.  

[carlyai]

Well i am fairly certain the cardiologist was talking about plaque that doesn't cause narrowing of the artery but bulges outward from the outside of the artery wall. So why would he say the scans so for are inconclusive and that if there is now plaque causing narrowing then no stent. Anyway will see. I have definitely been wrong before....once in 1965. ????

[carlyai]

18 minutes ago, carlyai said:

Well i am fairly certain the cardiologist was talking about plaque that doesn't cause narrowing of the artery but bulges outward from the outside of the artery wall. So why would he say the scans so for are inconclusive and that if there is now plaque causing narrowing then no stent. Anyway will see. I have definitely been wrong before....once in 1965. ????

Correction...no plaque causing narrowing.

[Sheryl]

3 hours ago, carlyai said:

Hi Sheryl, yes I am having an Antingham on the 8th of next month.

So this was what I have done: 1. I requested a calcium score test to check on plaque in my heart arteries. The test showed plaque build up mainly in one artery. Did a stress test on a treadmill and they found an extra heart beat for about 5 mins. on recovery. Saw cardiologist and he said we are sitting on the fence as not sure the plaque is blocking the artery or on the outside growing out. He said if the plaque is on the inside he will insert a stent.

So that is where I'm up to. 

I'll ask him more on the 8th and report back.

It seems strange to me,  that on the treadmill, raising my heart rate to (85% max or what ever it was they wanted), would increase my blood flow, and if I had a blockage i thought i should have felt it then, not on recovery.

Anyway I'm not a dr. And don't know. ???? Will soon but...

Stress tests miss 15% of blockages.

[4MyEgo]

4 hours ago, carlyai said:

It seems strange to me,  that on the treadmill, raising my heart rate to (85% max or what ever it was they wanted), would increase my blood flow, and if I had a blockage i thought i should have felt it then, not on recovery.

I had a mild heart attack over a decade ago at age 47, was a smoker till age 40. It happened because I overexerting myself, e.g. I was foolish after my divorce trying to score 4 goals in one day with a very pretty young lady....lol

 

Angioraphy was performed as soon as I made it to the hospital by car, and primary antioplasty (stent) was inserted in the proximal left anterior descending artery, I was told that a clot had formed and lodged itself in a narrow artery, but all was fine now, although I would be on meds for the rest of my life.

 

Can I ask how long you did on the treadmill for your exercise as you should have been given an Echocardiogram Report,  to reach the 85% target, and what the exercise time was, e.g. 13 minutes, and what your Pred. Max HR was, e.g. 162 bpm, and what the 85% Pred. Max HR was, e.g. 138 bpm. Also what  was the resting HR, e.g. 81 bpm, also what was the Peak HR, e.g. 182 bpm, along with the Resting BP 125/80 mm/Hg, and the Peak BP 170/70 mm/Hg and last but not least if the 85% of age-predicted maximum heart rate was achieved.  

 

The above are also good indicators on how the blood is flowing, I do an Echocardiogram every 5 years and although disappointed that I couldn't beat my previous 5 years of 13 minutes on the treadmill, the Dr said, give it a break as most who come back after 5 years can't achieve what they did previously, so I consider that a plus.

 

I wouldn't mind getting a calcium score test done as I haven't had one done before.

 

Hope you have insurance, noting that if you do end up getting a stent, you will probably be up for 1,500 baht a month for your meds here.

Edited September 28, 2021 by 4MyEgo

[ezzra]

From a person who has been trough those loops and hoops of blocked arteries, the best way to know and put your mind as ease to undergo an angiogram where your heart and it's arteries are being scanned to see if there are any blockages and should they find serious blockages they will recommend and angioplasty procedure where they insert catheter into the blocked arteries and open them up and will put you of statins medications like Lipitor and easytrol for the rest of your life...

[Sheryl]

2 hours ago, carlyai said:

Well i am fairly certain the cardiologist was talking about plaque that doesn't cause narrowing of the artery but bulges outward from the outside of the artery wall. So why would he say the scans so for are inconclusive and that if there is now plaque causing narrowing then no stent. Anyway will see. I have definitely been wrong before....once in 1965. ????

As I have ecplained plaque does not "bulge out". I am reasonably sure what he was referring to is what I described previously -- medial arteriosclerosis (which is a thickening/hardening of the artery and can predispise to aneurysm and othet cardiac problems but is not plaque) vs athersclerosis of the intima which is plaque and can obstruct. And he probably said this because of the clear stress test.

 

Both of these processes involve calcium so would show affect  CT score.

 

While medial arteriosclerosis alone does not obstruct and would not be treated with a stent it is far from benign. It is often associated with diabetes and with smoking.