Dead or Alive - Treat or Not to Treat,
That is the Question?
The process of deciding what is wrong with someone and what should be done to help improve the person's health follows a series of steps.
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In medicine, physicians are taught to develop SOAP notes.
These notes take information from the patient and people who have been watching or observing the patient, add that knowledge to the evaluation made by the physician, and then determine what the different possible problems might be, from which a decision is made as to what the next steps should be.
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S - subjective (patient and others)
O - objective (physician)
A - assessment (differential diagnosis of what the most likely problems are)
P - plan (how to proceed forward)
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The heart imaging with FMTVDM that we have looked at up to now, have looked for evidence of an InflammoThrombotic Immunologic Response (ITIR) Disease (ITIRD). This could include a variety of heart problems including:
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1) Coronary Artery Disease (CAD),
2) "Heart Failure" which includes both
a) right (top figure) and
b) left sided (bottom figure).
As shown previously, when areas of the heart are deprived of necessary blood flow to deliver live sustaining oxygen and nutrients to the heart, while removing metabolic waste products, including but not limited to carbon dioxide, tissue damage (myocardial infarction) begins on the inner surface (endocardium) furthest down stream.
As shown in the diagram above, the black area represents an area of the heart that was deprived of blood flow long enough to result in the death (infarction) of the heart tissue.
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The red areas were not deprived of blood supply or not deprived long enough to produce any type of tissue problem, while the blue area is defined as a "zone at risk".
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These blue "zones at risk" are those that with further insult (deprivation of blood flow or demand to work harder than their blood flow can adequately keep up with) for death (infarction) or rhythm disturbances (sudden cardiac death).
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The greater the amount of blue zone at risk tissue, the less likely that area of the heart will contract and pump blood; i.e. the greater the likelihood of "heart failure" - shown in the first two figures.
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The ultimate question is to determine if these areas of the heart, which are no longer helping to pump blood from the heart to the body, are dead or merely injured to such an extent that they appear dead but have not yet died and if the CAD is reversed, could recover and begin working again.
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​We call these areas stunned (if severely injured) or hibernating (less injured).
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Previous work that I published demonstrated that areas that were not functioning (stunned or hibernating) could be recovered if the blood flow was sufficiently improved. The research focused on changing diet and lifestyle with medical management based upon other health problems. [https://www.fmtvdm.com/contributions]
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This prior research showed that improvement in coronary blood flow could result in stunned or hibernating myocardium beginning to function, normalizing the wall motion and improving the amount of blood pumped out of the heart to the body (ejection fraction).
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As with the SOAP notes, it is important to decide what types of tests can provide us critical information about whether an area of the heart can potentially be restored versus being permanently damaged. This is critical for several reasons.
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First, if an area of the heart is permanently damaged, interventions including stents, angioplasty, bypass surgery or other interventions cannot make dead tissue living. All risk without the benefit.
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Second, if you know the area of the heart is stunned or hibernating, there is reason to persevere. There is an achievable goal at the end, with reduction in the ITIRD and resulting heart pump function.
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Third, improving the blood flow by reducing the ITIRD also reduces the risk of sudden cardiac death, as areas of partial ischemia (reduced blood flow) and not normally functioning heart tissue - including the electrical conduction system responsible for the rhythm of the heart - are associated with bad rhythms that can kill people (i.e. sudden cardiac death).
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Prior "qualitative" (it looks like) imaging has attempted to determine if the heart tissue is "stunned" or "hibernating" but like the visual images used for "ischemia" (i.e. CAD), there are limitations with visual "interpretation" of nuclear imaging results and absent "quantification" there is no "measurable" method for determining if the treatments being employed are working or not.
Just as we used FMTVDM following enhancement of coronary blood flow to determine the extent of the ITIRD within the walls of the coronary arteries, responsible for coronary artery disease (CAD), angina and myocardial injury (infarction, hibernation or stunning), so too can FMTVDM be used to obtain serial images which can be "quantified" to determine if these areas of the heart which grossly "appear" abnormal are "stunned", "hibernating" or "dead". Thus providing us with the necessary objective (O) information necessary to determine the best course of treatment for the person we are trying to help.
Utilizing FMTVDM Sequential Rest Images
at 5 and 60 Minutes
Following Injection of Isotope
WITHOUT ENHANCMENT.
Viable vs. Stunned Myocardium on FMTVDM©
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Definitions
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• Viable Myocardium:
Heart muscle tissue that is alive and capable of functional recovery if perfusion (blood flow) is restored, despite current dysfunction.
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• Stunned Myocardium:
A subset of viable myocardium—functionally impaired temporarily after an ischemic event (e.g., reperfusion following acute ischemia) but not permanently damaged.
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• Infarcted Myocardium:
Heart tissue (myocardium) that is dead and not capable of recovery of functioning again to pump blood to the body or function normally.
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FMTVDM© Resting Viability Principles
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FMTVDM (US Patent #9566037) is a patented nuclear imaging method that quantifies regional blood flow and metabolic activity in a single imaging protocol. It eliminates the guesswork associated with relative imaging and produces absolute quantification, allowing direct differentiation between tissue types and physiological states.
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FMTVDM (Fleming Method for Tissue and Vascular Differentiation and Metabolism) provides quantitative nuclear imaging to differentiate between various states of heart tissue, including normal, stunned, hibernating, and infarcted myocardium.
The comparison of 5-minute and 60-minute "measured" resting counts, make it possible to measure the initial distribution at 5-minutes, followed by measurement of isotope redistribution at 60-minutes. These measurements make it possible to distinguish between viable but dysfunctional tissue (stunned or hibernating) and non-viable infarcted tissue.
An example of counts obtained from an individual at 5-minutes (BLUE) and 60-minutes (GREEN) following isotope injection (sequential images taken at rest), reveals moderate "measured" uptake in the anterolateral regions of the left ventricle (pumping chamber pumping blood to the body) at 5-minutes.
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This was significantly reduced with "partial" washout, consistent with "stunned" myocardium by 60-minutes.
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By comparison, the mid anterior and basal (base) anterior regions had lower uptake at 5-minutes but retained the isotope at 60-minutes, demonstrating "hibernating" myocardium.
A simple review of the 60-minute images, as shown below, would suggest to most physicians reading the visual (qualitative) images, that the patient had experienced a myocardial infarction in the basal anterior and anteriolateral regions of the left ventricle. [The measurements have been intentionally blurred out to prevent the reader from seeing the FMTVDM measurements, which when compared with the other 5-minute resting image measurements, reveals these areas of the heart are not dead (infarcted); but rather, stunned or hibernating.
Thus, the use of FMTVDM, allows not only determination of the extent, severity and involvement of the ITIRD referred to as coronary artery disease (CAD); but, it also allows the measured determination of the extent of damage done to the heart.
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The measurement of this damage can be used to:
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1) Make treatment decisions based upon the ability to recover heart function and reduce the damaged tissue "zone at risk" increasing the risk of sudden death, and
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2) Measure treatment success and further progress towards restoring the health of the person's heart.
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For the purposes of tissue (heart) viability
Differentiation Using FMTVDM©
We now move forward to applying these same FMTVDM measurements and principles to the diagnosis and treatment of other ITIRDs, including
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Cancer and
Infectious Diseases.