HEART DIS­EASE:

Multi-slice com­puted to­mog­ra­phy

Milwaukee Health - - STAY WELL - ILLUSTRATIONS LIND­SEY BALBIERZ

Heart dis­ease is the No. 1 killer of Amer­i­cans, claim­ing some 800,000 lives in 2017 and ac­count­ing for one out of ev­ery three deaths. More than 90 mil­lion Amer­i­cans are liv­ing with the dis­ease to­day. Life­style changes are slowly mak­ing a dent in those grim sta­tis­tics, but we’ve got a long way to go. That’s why test­ing is so im­por­tant for peo­ple who are at higher risk.

Dr. Bi­joy Khand­he­ria, a car­di­ol­o­gist at Au­rora St. Luke’s in Mil­wau­kee and the for­mer chair of the Mayo Clinic’s Divi­sion of Car­dio­vas­cu­lar Dis­eases, says those risk fac­tors in­clude obe­sity, a fam­ily his­tory of heart dis­ease, high blood pres­sure (hy­per­ten­sion), di­a­betes, smok­ing, a seden­tary life­style and an ab­nor­mal choles­terol pro­file, mean­ing “bad” (LDL) choles­terol of 130 or higher and “good” (HDL) choles­terol of 39 or lower. Notably, one’s risk pro­file in­creases with age; sim­ply be­ing a male over 50 is con­sid­ered a risk fac­tor.

“Beyond the stress test, EKG and echocar­dio­gram, the best pre­dic­tor of dis­ease of the blood ves­sels is the car­diac, or multi-slice com­puted to­mog­ra­phy (CT) scan, also called a non­in­va­sive an­giogram,” Khand­he­ria says. This 3-D com­put­er­ized im­age mea­sures the amount of cal­ci­fied plaque in the blood and is ex­tremely ac­cu­rate in pre­dict­ing block­ages in blood ves­sels. Cal­ci­fied plaque is a key warn­ing sign of coro­nary artery dis­ease since it shows up long be­fore a heart at­tack strikes. The goal is to catch the prob­lem early and be­gin treat­ing it in hopes of pre­vent­ing a heart at­tack or stroke.

The test in­volves spend­ing 15 to 30 min­utes in a scan­ner, de­pend­ing on the age and speed of the ma­chine. Newer mod­els, such as the one at St. Luke’s, are faster and ex­pose the pa­tient to far less ra­di­a­tion.

Most at-risk peo­ple are good can­di­dates for this pro­ce­dure, with the no­table ex­cep­tion of those with ad­vanced chronic kid­ney dis­ease (CKD). Be­cause a dye is in­serted into the blood­stream, pa­tients with CKD may not be able to ex­crete the dye, which car­ries a low but real po­ten­tial of tox­i­c­ity. Also, hy­per­ten­sive and di­a­betic pa­tients need to be care­fully eval­u­ated by their car­di­ol­o­gist to asses them for risk of tox­i­c­ity. The scan may or may not be cov­ered by in­sur­ance, and it may or re­quire pre-au­tho­riza­tion or a pre­lim­i­nary stress test.

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