• Screening for Coronary Artery Disease (CAD) and Angina

    The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions. Most screening is aimed at primary prevention and identifying the risk factors associated with the development of CAD and angina .

    Screening Tests

    Blood Pressure Check
    High blood pressure is one of the most critical risk factors for CAD. Your doctor should check your blood pressure as a part of each exam. If you have chronically high blood pressure, your doctor may advise you of ways to monitor your blood pressure at home.
    Electrocardiogram (EKG)
    If your doctor suspects that you are at risk of developing CAD, you may have an EKG performed. This test records the electrical activity of your heart through electrodes attached to the skin. A “normal” EKG does not mean you are free of CAD, since most early changes are not seen on this test. But an EKG can sometimes document damage from an old, “silent” heart attack , as well as irregular rhythms.
    Blood Tests
    These are especially important in checking for diabetes (blood glucose) and cholesterol levels (total cholesterol, LDL, and HDL). C-reactive protein (CRP), a marker of inflammation, is associated with CAD and may be a helpful screening test in high risk populations. Although, the correlation between CRP levels and the extent of CAD is low.
    Chest X-ray
    Your doctor may order chest x-rays to check your heart's size and to check your lungs for signs of lung congestion.
    Cardiac CT Scan
    Also known as coronary artery calcium scoring, this noninvasive x-ray examination detects calcium levels in the coronary arteries, expressing the findings as a "calcium score". Calcium build-up is a marker of CAD.
    Existence of Erectile Dysfunction (ED)
    ED has been found to precede CAD by an average of 2-3 years. One study found that men with type 2 diabetes and CAD were almost eight times as likely to have ED as diabetic men without CAD.
    Ankle-brachial Indices
    Peripheral arterial disease (PAD) , the hardening of the arteries outside of the heart, is also a marker for increased cardiac risk. An ankle-brachial index measurement is done to screen for and diagnose PAD. Blood pressure is measured at your ankle and at your arm. If blood pressure is lower in your ankle, it indicates that an artery between your heart and your leg may be blocked. Atherosclerosis or hardening of the arteries is a systemic disease, and its presence in one area of the body increases your risk for disease in other areas as well.
    Carotid Intima-media Thickness (IMT)
    This condition is related to CAD, but research is inconclusive and the relationship is not clinically significant enough to recommend measurement of IMT as a screening tool.

    References

    American Diabetes Association website. Available at: http://www.diabetes.org/ .

    American Heart Association website. Available at: http://www.americanheart.org/ .

    Balbarini A, Buttitta F, Limbruno U, et al. Usefulness of carotid intima-media thickness measurement and peripheral B-mode ultrasound scan in the clinical screening of patients with coronary artery disease. Angiology. 2000;51:269-279.

    Coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD%5FWhatIs.html . Updated February 2009. Accessed June 18, 2009.

    European Heart Journal website. Available at: http://eurheartj.oxfordjournals.org/ .

    HeartInfo.org website. Available at: HeartInfo.org.

    Libby P, Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: WB Saunders; 2007.

    RadiologyInfo website. Available at: http://www.radiologyinfo.org/index.cfm?bhcp=1 .

    Zebrack JS, Muhlestein JB, Horne BD, Anderson JL. Intermountain Heart Collaboration Study Group. C-reactive protein and angiographic coronary artery disease: independent and additive predictors of risk in subjects with angina. J Am Coll Cardiol. 2002;39:632-637.

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