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The approach

Anatomy is what the artery looks like. Physiology is what the heart is doing.

The goal is not to overrule expertise. It is to understand the decision well enough to participate in it. These are questions to raise with your physician, not recommendations.

The approach

Anatomy is what the artery looks like. Physiology is what the heart is doing.

Anatomy

What the artery looks like.

A narrowing on a scan. It's the image that pulls attention toward intervention.

Physiology

What the heart is doing.

Whether the muscle is actually short of blood. You can't see it by looking at the artery alone.

In stable disease without limiting symptoms, intensive medical therapy may provide outcomes comparable to routine stenting. Acute coronary syndromes are different.

The method

Nine ideas worth understanding before your next cardiology appointment.

  1. Know your ApoB, not just your LDL. LDL-C measures the cholesterol carried inside particles. ApoB estimates how many atherogenic particles are circulating: the number with an opportunity to enter the arterial wall.

  2. Know your Lp(a). It is largely inherited, is not included in most standard lipid panels, and usually changes little with diet or exercise. Most adults need it measured at least once.

  3. Consider a coronary artery calcium score when appropriate. It is a quick, noncontrast CT test that can reveal whether calcified coronary atherosclerosis is already present. It is an alarm, not a complete investigation.

  4. Understand what anatomy can and cannot tell you. A calcium score and CCTA show plaque and narrowing. They do not, by themselves, establish whether the heart muscle is being deprived of blood.

  5. Separate anatomy from physiology. A frightening-looking narrowing and a flow-limiting lesion are related findings, but they are not the same finding. Sometimes both questions must be answered.

  6. Plaque burden and plaque biology both matter. The amount of plaque, what it is made of, and whether it is changing can add information beyond the percentage narrowing reported on a scan.

  7. In stable disease, intervention is not automatically the best first answer. For many stable patients without limiting symptoms or high-risk functional findings, intensive medical therapy may provide outcomes comparable to routine stenting. Acute coronary syndromes are different.

  8. Use AI to prepare, not to prescribe. AI can explain vocabulary, locate studies, compare tests, and help formulate questions. It cannot examine you, validate every source, or replace a qualified clinician.

  9. Take ownership without pretending to be your own cardiologist. The goal is not to overrule expertise. It is to understand the decision well enough to participate in it, ask better questions, and recognise when the evidence is incomplete or conflicting.

A better question

What should I ask at my appointment?

The goal is not to overrule expertise. It is to understand the decision well enough to participate in it. These are questions to raise with your physician, not recommendations.

Anatomy vs. physiology

The distinction the book keeps returning to.

  • “What is my physiology, not just my anatomy?”
  • “Do we know whether any narrowing is actually limiting blood flow, and would FFR-CT or a PET study answer that?”
  • “What is my plaque made of, not just how much there is?”

The numbers worth having

Several of these are absent from a standard panel.

  • “Can we measure my ApoB, not just my LDL-C?”
  • “Can we measure my Lp(a) once, since it is largely inherited?”
  • “What target would you set for me, and why that number?”

Before agreeing to a procedure

Understanding the decision well enough to participate in it.

  • “For someone in my situation, what is the absolute benefit of this treatment, not just the relative reduction?”
  • “If we treat medically first, what would we measure to know whether it is working, and when?”
  • “What would change your recommendation?”

heartCEO.ai is for informational and educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a qualified physician about your health and before making any medical decision. Seek urgent care for acute symptoms.

See how each test fits.

The Diagnostic Ladder lays out what each test measures and which question it answers.

Open the Diagnostic Ladder

heartCEO.ai is for informational and educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a qualified physician about your health and before making any medical decision. Seek urgent care for acute symptoms.