“Pop The Hood”: Using Carotid Ultrasound to Determine Risk of Stroke

Posted by: Men's Health Boston in Uncategorized on September 30, 2022

Picture this: it’s a Monday, 7:25 am, and you’re stuck on I-90, fighting your way through morning rush hour and sipping your Dunkin double-shot Americano. All of the sudden, the check engine light on your car comes on. What do you do?

If you’re particularly car savvy, maybe you drop by an auto parts store and borrow a scanner to see what codes are being thrown. But for most of us, the next steps are relatively clear – cross your fingers you can make it to work, then call around and find someone who can help you diagnose the problem. This second piece is critical, because finding a mechanic you trust can pay off in spades.

At face value, it might seem strange to compare car maintenance and healthcare, but the similarities might surprise you. After all, what is the heart if not the engine of the body? And ensuring your cardiac care to the right person is…dare we say it…even more essential than finding a good mechanic.

That’s because the most common diseases of the heart tend to develop over years, even decades. And much of the process of mitigating risk and avoiding tragedy depends on paying attention to proper maintenance, routine check-ups for warning signs, and occasionally popping the hood to see what’s going on underneath (so to speak).

So, in this month’s blog, we want to break down one of the most valuable non-invasive diagnostic tools in cutting edge cardiology care: the carotid ultrasound. 

What are the carotid arteries and why are they important?

If you think back to high school biology, you might remember that an “artery” is the umbrella term for any vessel that carries blood away from the heart. This blood is rich in oxygen and cellular components needed to make your body run properly.

The carotid arteries are the major blood vessels that supply vital nutrients to the brain, head, and face. So, you can imagine what would happen if a blockage occurred in one of these critical passageways. It would be bad; the “Ever Given blocking the Suez Canal” kind of bad. 

This can limit the free flow of oxygen and nutrients to the brain and muscles beyond, leading to a stroke, and explains why some of the telltale symptoms include facial numbness and difficulty with slurred speech.

How do these blockages happen?

Narrowing in the arteries, known as carotid stenosis, is typically caused by the build-up of fatty tissues called plaques that constrict blood flow. 

Another potential cause is something known as an atheroembolism. This happens when small pieces of cholesterol plaques or blood clots break off and travel downstream to block blood flow in smaller arteries. 

Fortunately, both issues can be assessed by carotid ultrasound.

How do you know if you should get a carotid ultrasound? 

At MHB, we’re strong proponents of looking directly at the blood vessel walls to accurately assess cardiovascular risk. That said, it’s not warranted for everyone who walks through our doors. 

One of the strongest clinical factors is something called a carotid bruit, or an abnormal sound related to blood flow. When your doctor puts a stethoscope on your neck to listen to the sound of blood moving through these arteries, the sound is distinctive. If something sounds strange, your physician might recommend further testing to determine the cause.

Are there any early warning signs?

Let’s return to our car analogy for a moment. One screening tool that serves as a “check engine light” in heart disease is the lipid panel, a test that measures the amount of cholesterol in your blood. 

That’s because cholesterol plays a strong role in the development of plaques in the blood vessels, and as those plaques grow, they become increasingly dangerous. However, just because elevated cholesterol CAN contribute to plaques doesn’t mean that it necessarily WILL. 

Not every patient with high cholesterol goes on to develop a carotid stenosis. Similarly, having “normal cholesterol” doesn’t GUARANTEE you won’t develop plaques. Just as you wouldn’t trust a mechanic who diagnosed the problem with your car based solely on the check engine light, we don’t diagnose your cardiovascular risk based solely on a cholesterol test. 

Instead, we “pop the hood” and take a look at the engine – or in this case, we use the carotid ultrasound to look at what is happening directly at the level of your blood vessels to find out if plaques are actually developing. It takes about 30 minutes, and can be done right in our Chestnut Hill clinic. 

What happens if you find plaque during the test?

If blood flow constriction is mild, your physician may prescribe a medication called a statin to help lower your cholesterol and prevent further plaque development. This is often done in conjunction with dietary and lifestyle counseling, a service we are proud to offer in-house to our patients.

In more extreme cases, surgical interventions such as stent placement or plaque removal may be warranted. 

I noticed that your clinic is called ‘Men’s Health Boston’. Do you also treat women?

Let’s address the elephant in the room: while our name pays homage to our history as the first comprehensive men’s health center in the U.S., we do treat women at MHB. 

In fact, because heart disease is the leading cause of death for women in the U.S. (accounting for approximately 20% of all deaths nationwide), we have a strong core of female patients who seek continuing cardiology care at MHB.

This is perhaps one of the strongest endorsements for Dr. Evan Appelbaum, MD, FACC, who owns and operates our practice. Dr. A (as he is affectionately known to patients) has over 20 years of experience as a researcher, medical professor, and clinician, managing the trickiest cardiac concerns of both the men and women who entrust their heart health to him. With a stellar reputation for exceptional patient care, Dr. A focuses heavily on preventative medicine and risk mitigation.

Sure, we’re biased; but we unabashedly believe he’s one of the best, and our patients agree. 

How do I schedule a Carotid Ultrasound consultation?

Dr. Appelbaum routinely accepts new cardiac patients for both ongoing disease management and preventative concerns. Request an appointment here, and one of our team members will reach out. If you have been recommended for further cardiovascular screening, ask for a referral to Men’s Health Boston. 

Additionally, if you or someone you know are suffering from urinary incontinence, sexual dysfunction, or hormonal imbalance, we’re here to help. For more information on our industry-leading care at Men’s Health Boston, click here.