Thanks for your response. I was always curious about something. My father inlaw was admitted a few years ago for bypass surgery. Upon inspection, they found (I'm doing this from memory so apologies if I get some of the numbers wrong) that 4 of his arteries were partially blocked, some up to 85%. In fact, his body produced a natural bypass on it's own because one artery was so clogged up (it literally created new connections to bypass the clog albeit much smaller then the original)!
My question is why can't we detect this high level of blockage much earlier (as in with a physical). Are the tests too intrusive or too expensive to recommend that the test(s) be performed periodically (eg maybe every 5 years after 30 or 40?)
Blockages of up to 90%, whilst considered 'critical', typically cause little in the way of symptoms.
The gold standard for detecting vessel blockage is angiogram- puncture the femoral or radial artery, feed a catheter to the top of the aorta and squirt some dye and then watch it on X-ray.
This has risks however- risks of rupturing artery walls, causing bleeding and bruising, and can be expensive. So it is not routinely done: in fact it is only indicated if a patient presents with a MI (gold standard is to have the patient in angio lab within 90 minutes of onset of symptoms, which is great because if they are they can generally reverse the blockages with stenting before long term damage occurs), or if a patient has a positive stress test.
CT angiograms are becoming more common but still not commonly used due to decreased sensitivity.
If a patient is believed to have risk factors for artery disease then they may be given a exercise stress test- hook up to an ECG, get on a treadmill and if there are changes consistent with vessel ISCHAEMIA (as opposed to infarct), then an angiogram will usually be scheduled.
For patients too unwell for a exercise stress test nuclear medicine stress tests can be performed.
And finally in patients who have blockages in more than 3 arteries, the gold standard is still (for the time being) coronary artery bypass grafting.
I guess to summarise, the reason we can't detect it earlier is because generally we require invasive means to do so and invasive tests carry risk to the patient that are hard to justify for screening purposes.
Perhaps in the future CT angio may be made more readily available, the scanners keep getting better and better and resolution increases all the time however you always want to minimise a persons radiation dose as for every 3-400 people scanned you can cause one instance of cancer... Something you must always be mindful of particularly in children
I didn't quite get the 90 minutes, got symptoms starting around 15:30, was in ED at 16:30 and getting the angio at 19:00.
The interesting thing (aside from watching the angio, the technology is very cool), was that I'd previously had a minor infarct and didn't know it on a much smaller artery.
They found collaterals (I think the terminology is right) where the body "bypasses" the blocked artery.
that is the right term - it happens when there are long term arterial subacute blockages - ischaemia/reduced oxygen flow triggers tissues to release vessel growth factors that will lead to extra artery growth.
Bizzarely this leads to situations where diabetics (who develop lesions all along their vessels, and thus have lots of areas of narrowing) can potentially be more protected from a sudden blockage compared to someone with an area of only one blockage - they have enough collateral circulation that the area of infarct is smaller with less damage resulting
I have the same question. I knew someone in their early 40s who had a heart attack recently. He seemed healthy otherwise - well ... he is borderline overweight compared to me. Why don't we have better diagnostics for this?
My question is why can't we detect this high level of blockage much earlier (as in with a physical). Are the tests too intrusive or too expensive to recommend that the test(s) be performed periodically (eg maybe every 5 years after 30 or 40?)
Thanks!