"Those who have the choice are spoiled for choice". This certainly applies to the diagnosis of coronary heart disease (CHD). There are various imaging procedures that can be used to diagnose the disease. But are stress echocardiography, a cardiac MRI or a cardiac CT scan the best option?
Coronary heart disease - The acne of the heart
Coronary heart disease is a circulatory disorder of the heart caused by vascular calcification. In CHD, at least one of the three coronary arteries that supply the heart muscle is narrowed or even completely blocked, so that the heart is no longer supplied with blood properly. This is caused by fat and calcium deposits, so-called plaques, which accumulate over the course of a lifetime and make the vessel wall appear uneven instead of smooth. It can be described as vascular acne, i.e. inflammatory changes to the vessel wall. These arteriosclerotic changes in the walls of the coronary arteries increase with age. However, many plaques on the vessel wall do not necessarily mean that a heart attack or stroke will occur - this risk also depends on the adjustment of the so-called risk factors.
Typical risk factors that favor the occurrence of coronary heart disease and other cardiovascular diseases in older people are high blood pressure, cholesterol, diabetes and smoking. For example, 75% of older people with high blood pressure also suffer from cardiovascular disease.
Symptoms of coronary heart disease
Shortness of breath, chest, arm and throat pain and reduced exercise tolerance, for example, are typical symptoms that can occur with CHD. This is due to the fact that the coronary arteries are too narrowed to transport sufficient oxygen to the heart.
A feeling of tightness in the chest can also be a sign of coronary heart disease in women. Figures published in the European Heart Journal in 2020 show that 16% of patients over the age of 65 with typical exercise-induced chest pain, i.e. angina pectoris, have been diagnosed with coronary heart disease. At 44%, this is significantly more common in men of this age. However, the frequency of CHD in old age is similar in women and men.
Diagnosis of coronary heart disease
In order to diagnose coronary heart disease, the medical history is the first and most important step. After asking about the patient's current health status, possible cases of coronary heart disease in the family and any other risk factors, such as arterial hypertension, obstructive sleep apnea syndrome, elevated cholesterol or lipoprotein a levels or diabetes mellitus, an ECG should be performed. Unfortunately, a resting ECG does not provide a reliable indication of the presence of coronary heart disease. Further additional examinations are therefore necessary. According to the guidelines, the next step is cardiac ultrasound (echocardiography). This allows the function of the heart chambers, the heart valves and the pulmonary pressure as well as the stiffness of the heart muscle to be reliably assessed.
In general, however, a cardiac CT scan is considered to be the best tool for the reliable diagnosis of CHD. It not only shows whether coronary heart disease is present at all, but also how severely the vessels are already narrowed if coronary artery calcification is detectable. Stress echocardiography (stress heart ultrasound) can be combined with dobutamine or physical exercise (treadmill, bicycle) and is best suited to finding out whether the heart muscle is still receiving enough oxygen through the partially narrowed coronary vessels. The same information can be obtained with nuclear medicine methods such as myocardial perfusion examination (scintigraphy), PET-CT of the heart (radiation exposure) or a cardiac MRI with adenosine or dobutamine exposure.
Coronary heart disease can therefore be best diagnosed with a cardiac CT scan. Stress echocardiography and stress MRI are less good at visualizing the coronary arteries and are better suited to clarifying symptoms, correctly adjusting medication and, above all, assessing whether an existing coronary artery disease is causing circulatory disorders that require further clarification with a cardiac catheter examination.
Three imaging methods for three different purposes
Coronary heart disease can therefore be diagnosed using stress echocardiography (stress ultrasound), cardiac MRI or cardiac CT. Which of these methods is most suitable in each individual case depends on the focus of the examination.
If you have any questions or require information, the team at the Im Park Cardiovascular Center will be happy to help.
