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Heart Disease

Symptoms/Screening for Coronary Artery Disease (CAD)

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Patients with coronary artery disease (CAD) often show no symptoms before experiencing myocardial infarction (heart attack). Approximately 50% of men and 63% of women who die suddenly from CAD show no previous symptoms of the disease. The degree to which patients experience symptoms of CAD varies, if they experience any symptoms at all. Also, women tend to experience different symptoms than men.

Typically, patients are screened for CAD during routine office visits, even if the patient has no symptoms of heart disease. Detection may also take place in the emergency room if a patient experiences myocardial infarction (heart attack). In some cases, angina (chest pain) and dyspnea (shortness of breast) may accompany CAD. Other symptoms may include:

tightness, heaviness, burning sensation, pressure, squeezing, or pain behind the breastbone or less commonly also in the arms, neck or jaws

nausea and vomiting

fatigue

sweating

weakness

CAD detection begins with a thorough physical exam, including careful documentation of family and personal history of heart problems and lifestyle factors, including smoking. In addition to a physical exam, blood cholesterol tests and blood pressure measurements are routinely used to help screen for CAD. Electrocardiogram and/or stress test may also be given. Recently, the U.S. government recommended aggressive new guidelines to help prevent heart disease. Click here to learn about the new guidelines.

Heart Disease Differences in Women and Men

Men have a greater risk of heart attack than women and are more likely to have heart attacks earlier in life than women. However, women are also at risk for heart disease. As a woman ages, her risk of heart disease increases: 9,000 American women under age 45 have heart attacks each year versus 250,000 women over age 65. Medical experts believe the increased risk of heart disease in older women is related to the depletion of the female hormone estrogen at menopause.

Many of the risk factors for heart disease are the same for women and men (see above section). However, other risk factors for women include menopause (specifically, loss of estrogen at this time) and the use of oral contraceptives among smokers or those with high blood pressure.

Women also tend to have different heart attack symptoms than men. The following chart summarizes these differences:

Heart Attack Symptoms
In Both Men and Women	More Often in Women Only
Pain/squeezing in middle of chest Shooting pain/numbness in left arm Sweating/nausea	Pain in the back, neck, or other areas Exhaustion/shortness of breath Stomach upset/indigestion Feelings of anxiety

Medical Tests to Detect CAD

Blood cholesterol: Blood tests to monitor cholesterol levels are typically performed once every five years for adults between the ages of 20 and 35 if the levels are normal. After age 35, cholesterol tests are typically monitored every two years or every year depending on age, family history, test results, etc.

Total cholesterol (mg/dL)	LDL cholesterol (mg/dL)	HDL cholesterol (mg/dL)
Ideal: Less than 200 Borderline high risk: 200-239 High risk: 240 and over	Ideal: less than 130 Borderline high risk: 130-159 High risk: 160 or higher	Ideal: 60 or higher High risk: lower than 40

Blood pressure: Blood pressure is usually taken during each office visit or other regular interval.

(mm Hg)	Ideal	Normal	High Normal	Hypertension
Systolic (top number)	Less than 120	Less than 130	130-139	140 or higher
Diastolic (bottom number)	Less than 80	Less than 85	85-89	90 or higher

*source: American Heart Association

Chest x-ray: A chest x-ray images the heart and surrounding thoracic anatomy, shows heart size and shape, and reveals whether the heart is misshaped or enlarged due to disease. Abnormal calcification (hardened blockage due to cholesterol build up) in the main blood vessels and fluid in the lungs (possible indication of congestive heart failure) can also be seen. Chest x-rays can also be used to image pacemakers and artificial heart valves to check for correct positioning.

Electrocardiogram (ECG or EKG): An electrocardiogram is a graphical record of the electrical activity of the heart. A normal ECG, in most cases, rules out the presence of other cardiac diseases. An abnormal ECG indicates the presence of a cardiac disease and further investigations are performed. An ECG can be beneficial in detecting the disease and sometimes even the extent of the disease.

Stress test: A stress test involves taking an EKG before, during and after a treadmill workout to detect possible cardiac disease and/or damage, including the extent of CAD. However, false positive results are possible with stress tests. A stress test is typically performed on adults 40 years of age or older who are at high risk for CAD.

This multi-slice CT image shows narrowing of the arteries (stonosis). Image courtesy of http://www.heartinformation.com

Fast/multi-slice CT scan: Fast/multi-slice spiral CT scan with ECG gating is a new non-invasive method of imaging the heart and coronary arteries. In some cases, ECG gated fast/multi-slice CT eliminates the need for conventional cardiac angiography which requires invasive catheterization. Fast/multi-slice CT is particularly useful in that it can show calcium deposits in the coronaries that form with plaque-build up and may eventually lead to myocardial infarction (heart attack). Early imaging of stenoses (narrowing of arteries) and calcium deposits in the coronary arteries can allow aggressive preventive measures or treatment to be implemented, thus lowering the risk of myocardial infarction.

3D reconstruction of the heart showing arteries in red

3D reconstructed heart showing coronary arteries in red, acquired with EBCT

EBCT has established itself as a very fast, non-invasive means to image the heart and coronary arteries. EBCT eliminates the need for catheterization and contrast injection which is required in conventional cardiac angiography. EBCT is particularly useful in that it can show calcium deposits in the coronaries. The calcium deposits form along with the plaque-build up and eventually lead to heart failure. Early imaging of calcium deposits in the coronary arteries can allow aggressive preventive measures to be implemented, thus lowering the risk of heart attack.

EBCT is a special type of computed tomography (CT) that uses a sweeping electron beam to create the rotating x-ray effect needed to make a computed tomography image. This makes EBCT different from conventional CT which has an x-ray tube mounted on a rotating frame. By using a sweeping electron beam, EBCT images can be acquired in as fast as 50 or 100 milliseconds, or some 10 times faster than the fastest slip-ring CT systems that can acquire an image in about 500 milliseconds. In order to image the beating heart and eliminate all image degradation caused by heart motion, image acquisition time must be in the 100 millisecond or faster range. In other words, a conventional slip-ring CT scanner can acquire one to two image per second while an EBCT system can acquire at a much faster rate of 10 to 20 images per second.

Ambulatory monitoring: If no abnormality, disease or damage is detected and the patient still feels uneasy when performing stressful activities (such as climbing stairs) but feels okay under normal activity, then an ambulatory monitor may be used. An ambulatory monitor is a portable EKG system (often worn around the waist) that continuously monitors the heart’s electrical activity.

Updated: Updated: February 29, 2008

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