Considering the huge economic toll of heart disease this may be on topic.
This video is literally jaw-dropping.
Wendy
4 Likes
Shouldn’t be to the folk who ought to know and ought to be exercising basic clinical evaluation skills when they first set eyes on a patient ….i.e. Primary Care Providers etc. As one of our pathology lecturers used to say (before I heard somethingsimilar credited elsewhere) “You can learn a lot just by looking”. I’ve posted a few of these examples in the past ….. including this one (the xanthelasma and xanthoma associated with FH) in response to one poster’s frequent inaccurate comment that “heart disease” wasn’t known until the 20th century….
Xanthelasma and lipoma in Leonardo da Vinci’s Mona Lisa - PubMed Xanthelasma and lipoma in Leonardo da Vinci's Mona Lisa - PubMed
I hadn’t known about this phenom related to the Mona Lisa until I heard it on a Peter Attia podcast. Sure enough, when checking further, I realised that there were plenty of examples on display (articles online and Grand Masters’ paintings hanging in museums)
2 Likes
…and then there’s personal experience. Dh had been totally unaware of his emergent AI (aortic incompetence) until the heart murmur was heard on our annual physical. It hadn’t been there a week earlier when he’d cleaned out the ear pieces on his own stethoscope and checked for sound on himself. By the time the daughter came round to drop Bebe off for her sleepover, the pulsating carotid artery and “water hammer pulse” were just evident (reason she returned with her portable ultrasound equipment) New aortic valve within 2 days….
My Afib was also a sudden onset, very characteristic, “irregularly irregular” heartbeat sensation…..”sneakers in a tumble dryer” is my daughter’s description. Immediate response to that too. The school fees were worth it!
1 Like
So, I got to wondering just how lng sone of these clinical signs and symptoms have been around (well, I knew some of them…like the pitting edema with heart failure from history of William Withering and use of foxglove/digitalis). So I checked on when Corrigan’s sign was named ……..and, lo, it was back in the early 1800s…
History in medicine: the aortic valve History in medicine: the aortic valve
I can see that self discipline with this rabbit hole is going to be necessary if I’m going to get through my to-do list!
I’m surely going to be able to amaze dh with some of the factoids I pick up in this treatise. Thanks for inadvertently directing me here, @WendyBG ….I think 
3 Likes
So, I had an entertaining read of this document and a few of the references but, really, the introductory paragraph speaks volumes. The overwhelming body of today’s knowledge has been built on the shoulders of those in the field years/centuries ago who laid the foundations (I’m not so sure about Galen…..he had some dodgy ideas in spite of seeing more than a few gladiators sliced open!)
In a way, it’s a bit misleading to be presenting these physical signs of heart disease as warning signs (especially in the context of ASCVD) since pretty much all of them are images/representations of late stage phenomena in a largely preventable disease. One that, for most part, takes decades to develop. The realisation that these cardinal signs are mostly named after anatomists, physiologists, physicians and surgeons etc from Days of Yore highlights the fact that, although these folk lacked pretty much all of today’s diagnostic armamentarium, they saw a lot just by looking. Couldn’t do an awful lot, mind.
Which brings me to the inescapable observation that, if someone actually notices these facial signs of ASCVD as a surprise ….the xanthalasma, arcus senilis etc (which can appear in the quite young) ….. whilst under the care of a physician, they should ask themselves just how long more actionable evidence has been ignored…..and why.
FWIW, I’ve seen early xanthalasma and the arcus in otherwisehealthy looking individuals a few times in my career (including the bloke I worked for back in England) …..but only in folk who already had their hypercholesterolemia diagnosed. Now I come to think of it, not for the past few decades ….. in spite of more diagnoses of “high cholesterol” …. since the introduction and widespread use of statin therapy.
This was the particular Attia episode that put my own genetic predisposition in context. Probably behind a paywall at the point where it gets interesting. Easier to remedy than a belated diagnosis of ASCVD.
#255 ‒ Latest therapeutics in CVD, APOE’s role in Alzheimer’s disease and CVD, familial hypercholesterolemia, and more | John Kastelein, M.D., Ph.D. - Peter Attia #255 ‒ Latest therapeutics in CVD, APOE’s role in Alzheimer’s disease and CVD, familial hypercholesterolemia, and more | John Kastelein, M.D., Ph.D. - Peter Attia
3 Likes
Because you are so highly educated and motivated to act as soon as you realize you have a problem, you may overlook the fact that many, many people (especially men) do NOT pay attention to their health. Much less proactively track physical symptoms that might cue them to a problem.
The real value of the video is that someone who doesn’t monitor their health might see one and say, “That looks familiar. Maybe I should see a doctor.”
Better late than never.
Wendy
2 Likes
Indeed but, recalling the narrative from the doctor presenting the video, within the first few minutes, she mentioned using, say, the xanthalasma as a reason to “talk to your doctor about….”. A comment that would suggest that any listeners are actually likely to already have a doctor. That’s the individual I’m also considering.
Certainly anyone who is currently on this board and one of the many “viewers” of the original video is educated enough to understand the value of screening for primary prevention of a serious life altering disease.
We don’t need a poll to tell us that, from past discussions on the topic, there are likely a good few who actually fall within your definition of not paying attention to their health or proactively tracking it. Heck, some have even announced the fact.
Not too hard to see why heart disease is the world’s #1 killer given that reality.
Right on cue, an article crossing my radar screen addressing my particular concerns with undiagnosed cardiovascular disease. Not the folk who don’t care enough, but rather folk like me (and you) who do care enough to pitch up at their PCP’s office for an annual physical……actually every year, too!! Willing to listen to advice and, at least, consider recommendations given.
Like a good many of the folk refered to in this article….whose first sign and symptom of heart disease was their heart attack….I too was low risk by standard guidelines. But with enough of a Red Flag to make an enlightened, thinking physician to say, “Now, that’s peculiar, I wonder if….?” But none did. I had to perform some diy doctoring.
A concept that bears repeating no matter how many times it’s fallen on deaf ears/blind eyes. For the reason given by @WendyBG ….. that someone who cares enough notices and wonders if what I’m talking about applies to them and asks their doctor specifically about something more than standard guidelines.
Better sooner rather than late.
In scrolling through my emails and deleting the majority, the latest from Peter Attia. This insight….that GLP-1 receptor agonists show benefit in cardiovascular disease independent of weight loss ….. was shared with me by my intervention cardiologist at my last visit. Maybe another tool in the treatment/prevention armamentarium?
1 Like