Technology is advancing quickly, and one of the biggest benefactors to that rapid change is health care. In fact, new imaging technology is allowing cardiologists to get a closer, more detailed look at CT angiograms to help determine how to treat coronary artery disease.
The new imaging technology is called HeartFlow, and it allows physicians to determine more easily if a patient needs an invasive procedure to clear blocked arteries or if a non-invasive treatment, such as medication, would work. Since 2018, more than 15,000 people around the world have used it, and it is offered in select locations throughout Banner Health.
Currently, Banner – University Medical Center Phoenix and North Colorado Medical Center in Greeley have HeartFlow available. Cecilia Hirsch, MD, is a cardiologist at Banner Health’s North Colorado Medical Center, and she helps us better understand coronary artery disease and HeartFlow.
What is coronary artery disease?
Dr. Hirsch explained that coronary artery disease is when the arteries that supply blood to the heart begin to get clogged with fatty and calcified deposits. This puts people at risk for heart attack and other forms of other heart disease.
While many people who have coronary artery disease will not have symptoms, some might. According to Dr. Hirsch, the most common symptoms usually happen when a person is exercising. These symptoms can include:
- Pain, pressure or discomfort in the center of the chest
- Pain, tingling or discomfort in other parts of the upper body, such as the arms, back, neck, jaw or stomach
- Shortness of breath
“Some patients with CAD can present with a heart attack or even sudden death as initial manifestation of the disease,” Dr. Hirsch said.
And, while coronary artery disease is often used interchangeably with coronary heart disease, or CHD, they are different. In fact, CHD is usually the result of CAD.
Who gets CHD?
As Dr. Hirsch pointed out, CHD is a major cause of death and disability in developed countries. In fact, it is responsible for about a third or more of all deaths in people over the age of 35. Estimates suggest that more than half of all middle-aged men and one third of middle-aged women in the United States will develop some form of CHD.
For American women, CAD is the most common cause of death. While premenopausal women rarely suffer from coronary diseases, such as heart attacks and sudden death, menopausal women’s risk drastically increases.
“Women often worry about getting cancer, especially breast cancer, as they get older,” Dr. Hirsch said. “But many more women die from heart disease than from breast cancer.”
In fact, about 1 in 5 deaths in women is caused by heart disease, according to the Centers for Disease Control and Prevention.
To detect CAD, your doctor may order an electrocardiogram, or EKG, which measures the electrical activity of the heart. Other tests that may be used include:
- Stress test—an exercise treadmill test
- Exercise or pharmacologic stress test combined with imaging, such as the nuclear stress test, echocardiogram or an MRI
- Cardiac catheterization or coronary angiograms, which involves inserting a thin tube into the radial artery in the forearm and guiding it up close to the heart
If the doctor determines you have CAD or are showing symptoms, he or she may choose to use a cardiac computed tomography (CT) angiogram, a newer test designed to detect significant coronary artery stenosis, which means a narrowing of the artery. The CT angiogram is a test that uses X-rays to provide detailed pictures of the heart and the blood vessels that go to the heart.
With the CT angiogram, the doctor may need to have it analyzed with HeartFlow, but this typically only happens in 20 percent of cases.
What is HeartFlow?
“HeartFlow is a new technology that makes the process of being tested for heart problems easier for patients,” Dr. Hirsch said. “It can provide information about the blood flow in a patient’s heart and determine whether a patient needs to continue with more invasive heart tests based on the images gathered.”
If the CT angiogram shows between 30 to 70 percent narrowing of the artery, the images are sent to HeartFlow for a detailed analysis. HeartFlow analysis helps determine which patients would need to have an invasive coronary angiogram or cardiac catheterization done. Studies have shown that, in cases where HeartFlow is used, 45 to 50 percent of patients did not need to have an invasive procedure done, which avoids having unnecessary procedures.
And, keep in mind, HeartFlow is used only in non-emergency cases of chest pain.
“HeartFlow is recommended by physicians to patients that are experiencing symptoms related to chest discomfort, tightness in their chest or other signs of possible heart problems,” Dr. Hirsch said.
How is CAD treated?
Dr. Hirsch noted there are a few ways CAD can be treated. First and foremost, lifestyle changes could be in order. According to Dr. Hirsch, these might include:
- If you smoke, quit
- Eat a heart-healthy diet by eating more fruit and vegetables and avoiding foods that have a lot of sugar
- If you’re overweight, lose some weight
- Exercise—take a walk or do some form of exercise on most days of the week
“Lifestyle changes also help prevent coronary artery disease,” Dr. Hirsch said.
Additionally, there are some medicines that can be very important. According to Dr. Hirsch, some of these medicines lower the risk of heart attacks and can help people live longer. These medicines include:
- Statins, which lower cholesterol
- Medicines to lower blood pressure
- Aspirin or other medicines that help prevent blood clots
- Medicines to treat diabetes
- Medicines to treat angina: nitrates, beta blockers, and others
In some cases, certain procedures may be needed to help improve the flow of blood to the heart, such as stents or bypass surgery of the blocked arteries.
If you are experiencing any pain or discomfort in the center of your chest, shortness of breath or pain and tingling in upper parts of your body, schedule an appointment with your doctor right away. If you believe you are having a heart attack, call 911 or get to an emergency department immediately.