Heart Disease UK

Most people who die from a heart attack had no previous symptoms. Knowing the physical condition of your heart could save your life. A quick and easy procedure, the Preventive Heart Scan tests men and women who may be at risk, even though they may be symptom-free. All you're required to do is hold your breath for about 30 seconds while the GE Light Speed CT scanner slides over your chest area as you're lying on your back, resting comfortably. You could be just a breath away from breathing easier about your heart health with this heart scan, which provides you and your physician with valuable information about the physical condition of your heart.
A PHS exam is an excellent tool for helping your doctor get the specific information needed to make a well-informed, accurate diagnosis, so he or she can provide you with the very best care. Your PHS exam will be a big comfort to your family, too. Since the scan is quick and easy, both you and your family -- as well as your doctor -- will get the answers you're looking for.

What's a cardiac score?
The CT images provide precise, high-resolution pictures of your heart's vessels. These images are evaluated to measure the calcium and plaque build-up that leads to heart disease. A board-certified radiologist reviews your test results and a cardiac score report is provided to you and your physician. Early warning signs of heart disease can assist your physician in recommending treatment or lifestyle changes that can slow, stabilize, or even reverse heart disease

The facts about computerized tomography (CT) and heart scans
• A computerized tomography (CT) scan is a valuable diagnostic medical tool combining X-rays and computer images.
• CT scans have been used successfully in diagnostic medicine for almost 30 years.
• CT scans are non-invasive, meaning that there is no penetration of the body, either by injection or incision.
• CT scans can be put together in a computer imaging program that shows a three-dimensional image of the heart for in-depth clinical evaluations.

Constantinos Anagnostopoulos and Richard Underwood

Despite major advances in prevention and treatment of coronary atherosclerosis, coronary heart disease (CHD) remains a major cause of mortality and morbidity in the western world. Its management consumes a large proportion of national health care budgets, a significant part of which is spent in imaging technologies. Amongst them, myocardial perfusion imaging (MPI) is an established technique with important applications in the overall management of CHD, including, diagnosis, prognostication, selection for revascularisation and assessment of acute coronary syndromes.
This supplement covers the current applications of MPI and also its cost effectiveness and use in clinical practice in the UK. In the first article, Loong and Anagnostopoulos perform a systematic review of the existing literature on the diagnosis of heart disease by radionuclide MPI. The message is that MPI possesses a high overall diagnostic accuracy and remains the standard technique for assessing myocardial perfusion in the everyday clinical practice.
The assessment of myocardial viability and hibernation in patients with cardiac failure is another area where MPI also plays an important role because it can assist in the differentiation of ischaemic and non-ischaemic aetiology and it is an optimal technique for management and assessment of prognosis.
Evidence from modelling and observational studies supports the enhanced cost effectiveness associated with MPI use. In patients presenting with stable or acute chest pain, strategies of investigation involving MPI are more cost effective than those not using the technique. Despite this and the fact that MPI is an integral part of many clinical guidelines for the investigation and management of angina and myocardial infarction, the technique is under-utilised in the UK as judged by the inappropriately long waiting times and by comparison with the numbers of revascularisations and coronary angiogram performed. In view of the publication of the UK National Institute of Clinical Excellence, guidance on the role of MPI in the diagnosis and management of patients with angina and myocardial infarction, we believe that the current supplement will be a valuable source of information for both providers and users of the technique.

From Richard N. Fogoros, M.D.
By DrRich

In standard textbooks of cardiology, much space is devoted to a description of the symptoms that typically occur with heart disease. In most cases, these "typical" symptoms turn out to be a recitation of the symptoms men get. In women, the symptoms can be quite different, and are usually regarded by cardiologists as being "atypical." However, since more women are dying from heart disease than men these days, it may be statistically more correct to consider men's symptoms as the ones that are "atypical."

Angina in women
When women have angina, they are more likely than men to experience "atypical" symptoms. Many women report a hot or burning sensation, or even tenderness to touch, in the back, shoulders, arms or jaw; often they have no chest discomfort at all.
Any good doctor will think of angina whenever a patient describes any sort of transient, exertion-related discomfort located anywhere above the waist, and they really shouldn't be thrown off by "atypical" descriptions. However, because many doctors persist in believing that CAD is uncommon in women, they are all too likely to write such symptoms off to mere musculoskeletal pain or gastrointestinal disturbances.
Myocardial infarctions (MI, heart attacks) also tend to behave differently in women. Frequently they experience nausea, vomiting, indigestion, shortness of breath or extreme fatigue - but no chest pain. Unfortunately, these symptoms are easy to attribute to something other than the heart. Women also are more likely than men to have "silent" MIs - that is, MIs without any acute symptoms, and that are diagnosed only at a later time when subsequent cardiac symptoms occur.

Chest pain with normal coronary arteries
Furthermore, women are more likely than men to experience true angina (chest pain due to a coronary artery disease) but with "normal" coronary arteries seen on cardiac catheterization.

Women minimize their symptoms
Women tend to complain less about their cardiac symptoms than men, thus leading doctors to think they are doing better than they actually are. Now, scientific evidence exists to show that, indeed, women tend to minimize their symptoms of cardiac disease.

By DrRich

Magnetic Resonance Imaging (MRI) has long been useful for diagnosing problems of the brain, spine and joints. Over the past decade, MRI has proven useful in diagnosing certain uncommon cardiovascular problems such as aortic dissection, cardiac tumors, and congenital heart disease. And MRI has proven a valuable research tool for studying more common cardiac disorders such as ischemia and cardiomyopathy. Until recently, however, it has been impractical to use MRI where it would be the most useful – in the routine evaluation and management of patients with coronary artery disease.
All that appears about to change. New techniques are becoming available that promise to deliver the holy grail of cardiology– a means to non-invasively image the coronary arteries – and to do it with far more precision than is achieved by today’s gold standard, coronary angiography.
In December, 2001, researchers at Harvard reported in the New England Journal of Medicine that they were able to use MRI scanning of the coronary arteries to detect disease in the major branches of the coronary arteries. They reported an overall accuracy of 72% with the MRI technique, and a much higher accuracy for disease of the left main coronary artery (which, while relatively uncommon, is the most dangerous place for a person to have coronary artery disease.)

What is MRI?
MRI is an imaging technique that takes advantage of the property of certain atomic nuclei (in this case, the single proton that forms the nucleus of a hydrogen atom) to vibrate – or “resonate” – when exposed to bursts of magnetic energy. When the hydrogen nuclei resonate in response to changes in a magnetic field, they emit radiofrequency energy. The MRI machine detects this emitted energy, and converts it to an image.
The MRI offers a potential means of detecting areas of cardiac tissue that have poor blood flow (as in coronary artery disease) or that has been damaged (as in a heart attack).
However, there are many technical problems in imaging moving structures like the heart with MRI. Movement of the heart during scanning significantly distorts the image (just as taking a photo of a moving object causes a blurring of the picture), and when the structures you are trying to see are small the movement problem becomes extremely difficult to overcome. Technology is progressing rapidly, however, and commercial MRI machines that can produce high-quality heart images are already being used in many research institutions.

How is cardiac MRI useful today?
While MRI machines abound in the United States, cardiac MRI, because of its complexity, has largely been limited to university hospitals where there is a strong research interest. Accordingly, much of the work with cardiac MRI has been done in the research setting.
Because of the difficulties in producing detailed MRI heart scans, only a few uses of cardiac MRI have become more-or-less routine. MRI has proven very useful in evaluating patients with aortic dissection prior to surgery. The detailed images offered by MRI tell the surgeon precisely where the “tear” in the wall of the aorta begins, and the full extent of the dissection. MRI can also locate and characterize the rare cardiac tumor. And in children with complex congenital heart disease, MRI can help to identify and “sort out” the various anomalies, and to plan potential surgical approaches to treatment.
While such applications of MRI are very helpful, these clinical situations are relatively rare. So cardiac MRI has yet to become a commonly used tool in clinical medicine.

What are some of the potential uses of cardiac MRI?
Once certain limitations are overcome – and that day seems to be rapidly approaching – the uses of cardiac MRI will explode.
MRI has the potential to diagnose heart attacks in patients presenting with chest pain. Not infrequently, a patient coming to the emergency room with chest pain will not have the typical ECG changes seen with myocardial infarctions, and the doctors end up waiting for an hour or two for the results of cardiac enzyme tests.
MRI can help distinguish between “stable” atherosclerotic plaques and “vulnerable” plaques. Vulnerable plaques are those that are prone to rupture, thus suddenly occluding a coronary artery and causing a myocardial infarction. If vulnerable plaques can be identified, those particular plaques can be targeted for intervention (angioplasty, stent, or bypass), while leaving the stable plaques alone.
MRI has already proven useful in the research setting for identifying restenosis after angioplasty. MRI might thus prove an accurate, noninvasive means of following patients after angioplasty.
MRI may replace the x-ray tube in both diagnostic and therapeutic situations. Research is already being done in animals using MRI to image the coronary arteries – instead of using fluoroscopy – for angioplasty procedures.

What about this week's report from Harvard on using MRI for diagnosing coronary artery disease?
Report in the New England Journal of Medicine constitutes another step forward, but MRI is still quite a ways from being ready to replace cardiac catheterization for most patients. While an accuracy of 72% is encouraging, it is certainly nowhere near the nearly 100% accuracy achieved with cardiac catheterization and coronary angiography. So, aside from the other disadvantages listed below, today the MRI is not accurate enough to substitute for coronary angiography when you really need to know the status of the coronary arteries. Indeed, while progress is ongoing, the MRI today is scarcely better in overall accuracy than the less inconvenient noninvasive tests that are used every day in cardiology.

Summary
MRI technology holds tremendous promise in the evaluation and treatment of heart disease. It is clearly technically feasible for MRI to replace – and significantly improve on – many of the sophisticated imaging techniques that are now routinely performed in cardiology. The potential for MRI to accurately diagnose and direct the treatment of coronary artery disease before it becomes clinically apparent is probably the most exciting prospect. Before this can happen, however, the amazing technology now being developed needs to be made accurate enough and inexpensive enough to achieve broad usage.