Ultrasound Carotid Artery

[harllee]

A couple of months ago I had some dental x rays (getting an implant) that showed a small amount of plaque on my left carotid artery (looks like a tiny dot on the X-ray). Dentist recommended I discuss with my doctor, I did and she recommended an ultrasound. Just had the ultrasound yesterday. Results say: "No sonographic evidence for hemodynamically significant stenosis." There is a bunch of numbers, etc and further in the report it says "intermediate echogenicity, non shadowing plaque of the left carotid bulb...no hemodynamically significance narrowing" Can anybody here tell me what this means?

I am sure I will hear from my GP and she will probably recommend all kinds of medication--blood thinner, statins etc. I am not big on taking medication unless I really need it. I do not take aspirin because I am allergic, makes me break out in hives.

I am female, age 73, very healthy, no history of stroke or heart disease (and none in my family), good blood pressure, good cholesterol numbers, eat healthy, exercise 5 days a week, not overweight, never smoked, drink an occasional glass of of wine. Currently I take no prescription medications. My Mother is still alive age 94 with Alzheimers.

 

[braumeister]

I believe it means you're fine.

 

[Trooper]

Your story sounds a little like mine, except my plaque was found as part of a voluntary Coronary Artery Calcium (CAC) test. My cardiologist ran a battery of tests, including a carotid artery scan and a nuclear treadmill stress test - all negative. However my doc still put me on a low dose statin, even though my cholesterol #s were good and I'm in otherwise good health like you. I pushed back a little, but he said that he likes to see LDLs in the 50s for patients with arterial plaque. So I complied .

ETA: I also believe your carotid scan is negative.

 

[fosterscik]

no hemodynamically significance narrowing

This is the most important news. You have no significant obstruction and your doctor will likely tell you the calcification is to the outside of your carotid artery and does lead to some hardening of arteries but poses very limit risk of future problems. He/she will likely put you on a statin to minimize future build up.

Your doctor may recommend a cardiologist follow up, and they may recomemnd a stress test and/or a CT scan of your heart to ensure there is no narrowing of those arteries.

I wouldn't worry. It was a very positive result.

 

[harllee]

Thanks everyone. I guess my question would be do I really need a statin?

 

[aja8888]

Thanks everyone. I guess my question would be do I really need a statin?

They may recommend one for safety sake. I had a carotid artery get loaded up last summer and ended up with a stent in it. Amazingly, no other arteries in my heart area or neck have any appreciable amounts of plaque and my cholesterol has always been around 160. I asked what they thought is causing this and the doc said "old age". So be it!

 

[Koolau]

Relax and then ask the doc your questions when you see her. If she says to take a med, I'd say, "take the med." You are paying her a lot of money to help you make decisions about your health. Either take her advice or find a new doc you trust.

Modern medicine has lengthened our lives and has been making the quality of our lives better. Enjoy living in such a time and don't let your natural reluctance to take meds hold you back from the best, longest life you can have.

Blessings on you.

 

[Chuckanut]

I taken the low dose statin myself. The lowest dose gives about 70% of the benefit. After that each doubling of the dose only gives a small benefit compared to the big reduction of the low dose. Read up on the statin 6% rule.

6 percent rule for doubling dose of a statin – Primary Care Notebook

An article from the cardiovascular medicine section of Primary Care Notebook: 6 percent rule for doubling dose of a statin.

primarycarenotebook.com

 

[Aerides]

Whenever I get test results for anything I Google all the terms before I see the doctor, and almost always it's "this is normal stuff" but it informs me. I tend to try to avoid AI and summary results and go directly to good medical sites (mayo) etc.

As far as the statin there are a number of factors your Cardio doctor will use to make that recommendation, or not. And it is almost never just from one scan, but your overall health, weight, cholesterol, activity, etc.

 

[MarieIG]

^^^ If you doctor recommends a statin, I would consider discussing the lowest possible dose to start, i.e. 5 mg of Crestor.

From a non-medical perspective, it appears that the artery is not significantly narrowed which is good, but - the doctor may want more testing to determine the extent of the non shadowing plaque (which, according to some, may be more likely to travel than calcified plaque).

I would also discuss with your doctor the applicability of low dose aspirin in your case (which is no longer recommended for primary prevention, but may be recommended for secondary prevention in patients where it is not contraindicated).

The below is a video which explains the difference between primary and secondary prevention and also some of the risks / benefits of baby aspirin, in particular noting those who should not be taking aspirin, if you are interested.

 

[harllee]

I cannot take aspirin, I have an allergy to aspirin. Break out in hives and lips swell up.

 

[MarieIG]

I cannot take aspirin, I have an allergy to aspirin. Break out in hives and lips swell up.

Ok than that is an easy elimination.

 

[harllee]

One more question. Should I be seeing a cardiologist? I have never been to one, my GP is a geriatric doctor.

 

[RetiredHappy]

Ask your GP to recommend a cardiologist to you. The short answer is yes.

 

[aja8888]

Everyone around 65 - 70 should start seeing a cardiologist.

Ask me how I know and I was in great health.

 

[Aerides]

One more question. Should I be seeing a cardiologist? I have never been to one, my GP is a geriatric doctor.

Yes for sure.

ETA: not to be an alarmist at all, but you're in specialist territory. Much like a bad knee would send you to the ortho.

I have a very small number of PVC's, but my primary sent me to a cardio before she'd do a minor surgery approval. He did an EKG/Echocardiogram/Stress test, and had me wear a holter monitor. All clear, but now I follow up with him annually.

 

[RetiredHappy]

Everyone around 65 - 70 should start seeing a cardiologist.

Ask me how I know and I was in great health.

My concierge PCP referred me to a cardiologist last year. The cardiologist said, "Why are you here? Your CAC score is 0, EKG (done by my PCP) is normal and your cholesterol is great." He didn't even touch me, and dismissed me.

 

[harllee]

I wonder, should everyone over 70 get a carotid artery ultrasound? I only got it because something accidently showed up on dental X-ray. I have never had a stress test or EKG or anything heart related.

 

[aja8888]

I wonder, should everyone over 70 get a carotid artery ultrasound? I only got it because something accidently showed up on dental X-ray. I have never had a stress test or EKG or anything heart related.

My EKG last July showed my heart was skipping a beat every so often. It is an electrical problem and things like this get more common as we age. I was a competitive long distance runner for decades and have a strong heart, but all of a sudden, it's skipping a beat. Hello pacemaker.

I passed a stress test with great numbers at 81 years old and never had a issue with plaque or any other vein related problem.

 

[razztazz]

I wonder, should everyone over 70 get a carotid artery ultrasound? I only got it because something accidently showed up on dental X-ray. I have never had a stress test or EKG or anything heart related.

I started getting them every 2 years starting right about 50. I am going on 68 so I've had a ton of them. They're pretty cheap, have no side effects and no exposure to "rays" like x-rays.

Once about 10 yrs ago one side showed the lowest level of detectable plaque. The upshot was: Perfectly normal. A consequence of aging. Almost nobody will show zero at your age. Every single one after that showed "Zero", so A) false positive and B) definitely not progressing.

Since then, as recently as 2023, I've had a couple CT scans of my head and neck with an actual neurologist presiding. Had my whole head examined and still nothing to see in there.

(yes, I know. I said that on purpose)

 

[RetiredHappy]

My PCP does the EKG in his office as part of the annual examination, along with the muscle/fat body composition machine, hearing and breathing test. Cognitive test if we are above 65 years old. We skip the vision test as long as we are seeing an ophthalmologist.

My husband got a 2 out 5 on his mild cognitive impairment test, which we think is incorrect. It's scored by the app on the tablet. My PCP said next year they will do it manually with him.

 

[mountainsoft]

It's good you got it checked when the dentist noticed something. It sounds like you're okay.

My mom had one of her carotid arteries completely clog and she had a stroke in 2017. There's a medical term for it, but her vascular surgeon basically "roto rootered" her artery to clear out most of the plaque. Her other arteries are quite clogged too (80%+ I think), but the doc said they don't risk the surgery unless they reach a certain level (8 years ago, can't remember now).

Mom smoked and drank most of her life, and ate a poor diet heavy in beef and processed foods. She mostly recovered from her stroke, but still has a few subtle side effects with speech, hand movements, and thought processing.

 

[harllee]

OP here, I have talked to my GP, she says I am fine, only a tiny dot of plaque shown on the ultrasound and no narrowing of the artery. She does not think I need to see a cardiologist or get any more tests at this time. She did recommend that I start a very low dose statin to get my cholesterol down a little bit so I am going to try that.

 

[Koolau]

OP here, I have talked to my GP, she says I am fine, only a tiny dot of plaque shown on the ultrasound and no narrowing of the artery. She does not think I need to see a cardiologist or get any more tests at this time. She did recommend that I start a very low dose statin to get my cholesterol down a little bit so I am going to try that.

Fantastic! So glad to hear your news.

 

[badatmath]

I have seen 3 cardiologists and have not great cholesterol numbers. . . not one has suggested a statin. I asked why (not that I wanted one) and they said my other test results indicate no need for it (at this time). Something to the effect it is clearly normal for me as I'm not accumulating plaque. (They have been in there with a camera looking) IDK. Fortunate for me as I didn't want one.