Unmasking a menace

    Cardiovascular disease (CVD) is America’s foremost killer. About 80 million citizens have some form of it—many people, in fact, have multiple forms—and almost 900,000 die from CVD each year.
    With those statistics, it’s no wonder doctors do all they can to spot heart trouble early. Fortunately, your physician can rely on an ever–increasing number of diagnostic tools that identify heart disease before it becomes life–threatening.

Dr. Detective

    Your doctor may suspect heart disease whenever a physical exam or personal or family medical histories suggest you’re at risk. Common warning signs include high blood pressure; rapid pulse; difficulty taking deep breaths; or a history of hypertension, heart attack or stroke.
    If that’s the case, you’ll probably undergo some basic screenings, such as a blood test to check cholesterol and triglycerides and perhaps a chest X–ray of your heart.
  

Outside looking in

    In addition, your doctor may turn to the new generation of diagnostic exams developed in the last 20 years. These precise and insightful tools help confirm a diagnosis of angina, atherosclerosis, coronary artery disease and other forms of CVD. Examples are:

    • Radiographic imaging techniques. These are today’s cutting–edge diagnostic tools. Here are three principal types used:

    • Positron emission tomography (PET) lets doctors see metabolic activity in tissue and organs. In this painless procedure, patients get a safe, low–level intravenous injection of glucose—a carbohydrate used by almost all cells—mixed with radioactive isotopes that emit positrons. Heart disease causes damaged cells to absorb glucose at a different rate than healthy tissue, so as the mixture flows through the arteries and heart, the PET scan detects the way positrons are absorbed and then released from the heart or arteries. Radiologists then interpret these images to see exactly where the damage is and how far it’s spread—data no other test currently collects.

    • Computerized tomography (CT) is an X–ray that’s 100 times more sensitive than a standard X–ray. CT creates two– and three–dimensional images of the cardiovascular system by snapping ultra-thin “slices” of the body from various angles. In minutes, computers assemble the slices into high-resolution images that reveal clots, arterial blockages or aneurysms. The patient may be injected with dye to help the scanner make the most detailed pictures possible.

    • Magnetic resonance angiography is a special MRI that targets the blood vessels. The patient is usually injected with contrast dye, then the magnet aligns the water molecules in the body toward it. Radio waves coax the molecules to send back faint signals, allowing a computer to assemble images of the blood vessels.

    • Nuclear ventriculography. During nuclear ventriculography, doctors inject radioactive isotopes into the patient’s bloodstream. The compound binds to red blood cells. Special scanning equipment then follows the isotopes as they journey through the heart and major arteries. These scans detect the heart’s size, condition and how much blood is entering and leaving its pumping chambers. Two scans are often taken: One while the patient is resting, the second during exercise.

    • Catheterization and angiography. These tests find blockages in the heart and coronary arteries. In catheterization, doctors mildly sedate the patient, then guide a catheter—a long, thin plastic tube—through an artery in the arm into a heart chamber. Doctors can then assess the pressure and flow rate of blood and collect blood samples.

Have a heart

    These and other procedures help confirm a diagnosis so that any prescribed therapy can be effective and beneficial. They’re designed to yield an enormous amount of information about the heart. But the most important thing to remember is that the sooner heart disease is detected, the easier it will be to manage.