Angina (cont.)
Angioplasty and coronary artery bypass surgery
When patients continue to have angina despite maximally
tolerated
combinations of nitroglycerin medications, beta blockers and
calcium channel blockers, cardiac catheterization with coronary
arteriography is
indicated. Depending on the location and severity of the
disease in the
coronary arteries, patients can be referred for
balloon angioplasty
(percutaneous transluminal coronary angioplasty or PTCA) or
coronary
artery bypass graft surgery (CABG) to increase coronary artery blood
flow.
What's new in the evaluation of angina?
A newly developed computerized x-ray scan (ultrafast CT scan)
is highly
accurate in detecting small amounts of calcium in the plaque of
coronary
arteries. If an ultrafast CT scan shows no calcium in the
arteries,
atherosclerotic coronary artery disease is unlikely. Ultrafast
CT scanning is useful in evaluating chest pain in younger
patients (men
under 40 and women under 50 years old). Since young people do
not normally
have significant coronary artery plaque, a negative ultrafast
CT scan
makes the diagnosis of coronary artery disease unlikely.
However, finding
calcium by this method is less meaningful in older patients who
are likely
to have mild plaquing simply from the aging process.
Even though an ultrafast CT scan is useful in detecting calcium in plaque, it cannot determine whether the calcium-laden plaque actually causes artery narrowing and reduces blood flow. For example, a patient with a densely calcified plaque causing minimal or no artery narrowing will have a strongly positive ultrafast CT scan but a normal exercise treadmill test. In most patients who are suspected of having angina due to coronary artery disease, an exercise treadmill study is usually the first step in determining whether any plaque is clinically significant. Newer very high speed CT scanners can actually detect true coronary artery plaques and lesions similar to coronary angiography.
Magnetic resonance imaging (MRI), using magnetism and radio waves, can be used to image (produce a likeness of) the blood vessels. Currently, the larger vessels, such as the carotid arteries in the neck, can be imaged using this technique. Future software and hardware improvements may allow screening of the heart's arteries with magnetic resonance testing.
Next: What's new in the treatment of angina and heart attacks? »
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