South Florida Hospital News
Thursday August 6, 2020
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February 2007 - Volume 3 - Issue 8
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Patients with Heart Disease Benefit from Less Invasive Diagnostic Approach

For years, patients who were suspected of having heart disease had to undergo a litany of tests, and invasive, uncomfortable catheterization to determine a diagnosis. Today, patients have the advantage of coronary CT angiography, which enables physicians to view the heart and coronary arteries in a minimally invasive way.

"In the past, the traditional evaluation for heart disease included EKGs, nuclear stress tests and invasive catheterization," explained Dr. Evelio Alvarez, medical director of Radiology at Westside Regional Medical Center (WRMC), a 224-bed facility in central Broward County. "Now we use a new modality, coronary CT angiography, that allows us to visualize the coronary arteries to evaluate calcification and fatty plaque."

During the catheterization procedure, an IV line is inserted into one of the blood vessels in the groin, and a catheter is inserted through the IV into the blood vessel. The catheter (a thin, flexible tube) is threaded into the right or left side of the heart in order to visualize the heart vessels.

"CT imaging reduces the need for invasive work-up to the patient, and also decreases the need for a prolonged stay at the hospital," said Dr. Alvarez. "After diagnostic catheterization, patients would need to stay in the hospital for observation for four to six hours—with CT imaging, patients come to the hospital in the morning, spend about two hours in prep, and go home immediately after their scan."

During the CT procedure, a full medical history of the patient is compiled, and the patient’s heart rate is monitored until the number of beats falls below 60 beats per minute. Beta blockers may be given to slow the heart rate down. Once the rate is within range, patients receive contrast via an IV, and the CT scan is performed. The scan itself takes less than one minute.

Throughout the process, an EKG machine monitors patients’ heart rates. "The procedure is fairly painless, though patients may feel a heat sensation when the contrast is fed through the IV in their arms," Alvarez said.

At Westside Regional Medical Center, CT scanning is performed with a state-of-the-art LightSpeed VCT, the world’s first Volume Computed Tomography (VCT) system. Though this technology, physicians are able to capture images of a beating heart in five heartbeats, and an organ in one second. It can also be used to perform a whole body trauma scan in 10 seconds, which is more than twice as fast as conventional multi-slice CT scanners. This speed is especially helpful in shortening breath-hold procedures for geriatric patients and patients who are on ventilators.

Though most patients are able to undergo a CT scan, Dr. Alvarez says that they are not appropriate for patients with cardiac pacemakers, those with cardiac arrhythmias or people who are allergic to iodine. "Because we need to get the heart rate down before performing the scan, some patients who cannot get their heart rate down are also not able to undergo the procedure as well as patients intolerant to beta blockers," he said.

CT scanning can often be a good alternative for patients who cannot undergo diagnostic cardiac catheterization. "Some patients, such as those who are too critical to undergo an invasive procedure like catheterization can undergo a CT scan," said Dr. Alvarez. "CT scanning doesn’t eliminate the need for catheterization in the case of acute chest pain, however—it is more for use in clinically stable patients."

"If patients are found to be positive for coronary artery disease, they may also undergo catheterization for ‘interventional’ treatment, like the placement of stents," he added.

Through the use of CT scanning, physicians can determine whether chest pain is indicative of coronary artery disease, or eliminate its possibility. If the CT scan discovers coronary artery disease at an early stage, steps can also be taken to deal with the disease. "If discovered early on, medical intervention can prevent, or even reverse, coronary artery disease," said Dr. Alvarez. "We can prevent it from escalating into a myocardial infarction (heart attack) or the need for a bypass procedure."

For more information on CT imaging technology and its use in detecting coronary artery disease, call Westside Regional Medical Center at 1-866-4-HCA-DOCS or visit www.WestsideRegional.com.
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