Volume 3 Issue 2

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While some tests directly check artery walls for evidence of vascular disease (i.e. the cIMT, CACS, and AAA scan), other tests look at blood flow and signs of blockages in the arteries. The problem is, 99 percent of plaque does not obstruct blood flow yet can still cause a heart attack if it becomes inflamed and ruptures (think of a volcano in your artery). That eruption can result in a blood clot that causes a heart attack or stroke. So, it's important to remember that angiograms, stress tests, and the Heart SPECT scan check only for blockages and, therefore, offer a less-comprehensive assessment of vascular health. Coronary Angiogram An angiogram has a simple mission: to determine if your arteries are blocked. Healthcare providers use data from an angiogram to decide if a patient needs invasive procedures, such as angioplasty (a "balloon" inserted into the blood vessel to reopen the clogged area) or bypass surgery. Angiograms are typically ordered for people with symptoms that could signal reduced blood flow through the coronary arteries, such as crushing or squeezing chest pain, pressure or tightness (angina), shortness of breath, dizziness, fainting or unusual fatigue during exertion, and excessive sweating. The test may also be performed to evaluate patients with heart failure, heart attack symptoms, chest injury, heart valve disorders, or congenital heart defects. Because an angiogram is an invasive test with small, but serious risks, it is generally not advised to evaluate asymptomatic patients. Despite this knowledge, angiograms are a common scenario when an asymptomatic patient consults a cardiologist after a noninvasive scan, such as cIMT, the coronary artery calcium score test, and shows plaque buildup. Very often, instead of investigating why an otherwise healthy patient - who could run on a treadmill at high speed without any chest pain or other cardiac warning signs – has diseased arteries, the doctor will instead order an unnecessary angiogram to find out how big the blockages are. This frequently leads to patients being told they urgently need a stent or bypass, when their disease could safely be managed without surgery. Normal results suggest that blood is flowing freely, with little or no narrowing of the vessels. Many patients with "normal" results, however, have dangerous atheromas in their coronary arteries, and abnormal results indicate some obstruction in arterial lumen. If the obstruction is less than 50 percent, patients are usually told they have "mild" disease. This is despite the knowledge that 68 percent of heart attacks arise from plaques less than 50 percent obstructive. If the blockage is greater than 70 percent, it is usually assumed to be related to the symptoms and invasive intervention is considered. Heart SPECT Scan Heart SPECT (Single Photon Emission Computed Tomography) is the most common "nuclear" heart scan used to look for indirect signs of heart disease, by evaluating blood flow through the coronary arteries. It can also detect damaged heart muscle – say, from a prior heart attack or infection – and measures how well your heart is pumping blood to the rest of the body. You're a candidate for this test if you have symptoms of coronary artery disease or failed an exercise stress test. It might also be reasonable for patients who have indirect evidence of significant coronary artery disease such as a very high calcium score. It is recommended for anyone with type 2 diabetes, even if he or she is asymptomatic. By the time someone develops diabetes, that person may have so much nerve damage that even if the heart is not being adequately supplied with blood, he or she may not have symptoms. Another recent study of symptom-free patients Page 44 | Abby's Magazine - Tests That Check for Blockages

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