Peaceful Times

Wolfgang - ClinicaWhen the Christmas bells are ringing, our arteries will once again groan loudly. The traditional Christmas dinner of most Europeans alone will clock up an extraordinary 3000+ calories and Christmas does not end with the dinner.

Most likely the discomfort in the pit of the stomach then really is caused by indigestion, but what is actually nowadays available in terms of investigating angina; the term which stands for chest pain caused by the narrowing of the blood vessels of the heart?

The typical symptoms are indigestion-type central chest pain +/-, radiating into the left inner arm often associated with shortness of breath, nausea and/or sweating. But up to half of people do not get typical symptoms. Therefore a firm diagnosis must be established.

Everybody will have heard of the so-called, exercise tolerance test; the heart is made to work hard through exercise on a treadmill or a stationary cycle and at the same time an ECG is recorded to look for typical changes. Angina can only be seen on the ECG, when the heart starves of oxygen and by pumping faster the oxygen demand obviously rises. Therefore a resting ECG is not sufficient.

For some patients exercise is not possible due to lung disease or arthritis, so the heart can be made to work hard by administering certain medications, which commonly is the case in ultrasound tests of the heart and tests using radioactivity, which currently loses its importance due to relatively high radioactivity exposure and newer methods.

Coronary angiography is also widely known, but this is an invasive procedure where a thin tube is put into a blood vessel of the arm, groin or neck and threaded into the heart arteries.

Then a contrast substance is injected into the bloodstream making the coronary arteries visible on the x-ray pictures. It can cause serious complications and because of its invasiveness it obviously is not a first line choice for little suspicious symptoms.

The advantage of coronary angiography is that when a blockage has been discovered it may be dealt with immediately by widening it with a stent.

Contrast-enhanced, computed-tomography angiography (CTA) is a fairly new noninvasive test that requires the use of intravenous contrast substance during a computer tomography of the heart to obtain detailed images of its blood vessels. It seems nowadays a potential alternative to the current tests for angina, i.e. non-invasive exercise stress test and/or invasive coronary angiography.

Doing a test and getting a result in medicine is hardly ever unequivocal. It is a question of probability – of sensitivity and specificity. Sensitivity means the likelihood that the test actually diagnoses what it is supposed to diagnose which is up to 72% with the exercise tolerance test. This means that 28% of angina sufferers may be missed. Specificity means that the test diagnoses correctly that one does not suffer from a condition.

In our example this is around 75%, which means 25% of healthy subjects may be diagnosed with angina. The accuracy apparently increases with CTA to 95% and 88% respectively thus helping to avoid unnecessary invasive testing.

People who do not suffer from any type of chest pain actually have a low risk of getting diagnosed with angina but reducing risk factors is still the best way to stay heart-healthy and for that we luckily have got the New Year´s resolutions.

In this spirit our team wishes all of you a Merry Christmas and Happy New Year!

(News/Medical: Angina vs. Indigestion; excessive Christmas eating)

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