How to diagnose coronary artery disease


Diagnosing coronary artery disease can challenge both patients and doctors because many people are at risk of developing coronary artery disease and so many tests can be utilized. Who should be tested, and what tests should they undergo?

What is coronary artery disease?

Coronary artery disease is a chronic disease of the coronary arteries. In coronary artery disease, atherosclerosis causes the smooth and elastic arterial path to becoming hard, stiff and swollen by "plaque," which is a collection of abnormal calcium, fat, and inflammation of cells.

This plaque can protrude in the arterial canal, causing blockage in part of the bloodstream, a condition that often causes angina. Plaques can also suddenly rupture, causing blood clots to form in the coronary arteries which result in a sudden blockage of blood flow. Most infarction of myocardial (heart attack) due to acute plaque rupture.

Coronary artery disease is a chronic and progressive disease that usually occurs for several years before someone is aware of something wrong with them. The first indication that often arises is that there are problems when unchanging events occur, such as myocardial infarction or heart attack. This means that if you are at high risk for coronary artery disease, you don't have to wait for the symptoms to appear before finding out if you have a problem.

The following are ways to diagnose if you have coronary artery disease.

1. Identify "significant" blockages

Traditionally, the diagnosis of coronary artery disease has relied on tests that look for evidence of "significant" blockage in the coronary arteries. In general, cardiologists consider a "significant" blockage to block 70% or more of the arterial canal.

Sports tests (or stress tests) often help diagnose partially blocked coronary arteries. Controlled stress tests are often able to find symptoms of angina and changes in characteristics of an electrocardiogram (ECG) - a finding that indicates a blockage.

Perform a stress test along with a thallium / cardiolite study or an echocardiogram to increase the ability to find partially blocked coronary arteries. Thallium and Cardiolite are radioactive substances that are injected into blood vessels during exercise. This substance is channeled to the heart muscle by the coronary arteries, allowing the heart image to be displayed with a special camera. If one or more coronary arteries are partially blocked, the area of ​​the heart muscle supplied by the artery appears in the image as a dark spot.

Echocardiograms create images of the heart beating with sound waves. The abnormal movement of the heart muscle seen on the echocardiogram during exercise is probably coronary artery disease.

If a stress test states that there are one or more blockages, the patient is generally referred for cardiac catheterization. The purpose of catheterization is to fully characterize the location and extent of all blockages of coronary arteries, usually with the aim of angioplasty, stenting, or bypass surgery.

Noninvasive tests are being developed which may one day replace the need for cardiac catheterization, including CT scans of multiple incisions and cardiac MRIs. Unfortunately, there is no current approach that can completely replace the need for cardiac catheterization.

2. Identify plaques that do not cause significant blockages

In recent years, cardiologists have known that myocardial infarction and unstable angina are caused by plaque rupture in the coronary arteries. It turns out that in most cases, plaques that eventually break up will have been considered "non-significant" (ie not causing significant blockages) before rupture. This is why we often hear people suffer from heart attacks immediately after being told that they do not have significant coronary artery disease.

Because any plaque can break, it is important to know if there is even the smallest plaque. People who have coronary arteries must take steps to stabilize plaque and reduce the risk of plaque rupture. (these measurements often include addressing risk factors, lifestyle changes, statins, and aspirin.)

Calcium scans are a useful way to detect even the presence of mild coronary artery disease. A calcium scan is a form of CT scan that can calculate the amount of calcium in the coronary arteries. Because calcium usually appears in plaque, measuring the amount of calcium in the arteries gives an indication of whether there is coronary artery disease (and later plaque) and the spread of coronary artery disease.

By warning you that you have at least enough coronary heart disease to produce "quiet" plaques, calcium scans can give you a chance to change your lifestyle, and maybe take the right medication, when there is still time to do it.

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