CT, MRI, and other forms of angina evaluation

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor I Tran Cong Trinh - Radiologist - Radiology Department - Vinmec Central Park International General Hospital. The doctor has extensive experience in the field of diagnostic imaging.
Angina is a temporary chest pain that causes discomfort due to reduced blood flow to the heart muscle. Angina is not a heart attack, but it is a sign of an increased risk of heart attack. Angina may be stable (more severe with physical activity, lasting five minutes or less and relieved by rest) or unstable (occurring only during rest, longer and symptoms may be more severe.

1. What is angina?

Angina is a temporary, uncomfortable chest pain caused by reduced blood flow to the heart muscle. Due to reduced blood flow, not enough oxygen reaches the heart muscle resulting in chest pain. Coronary artery disease can lead to narrowing of the coronary arteries that carry blood and oxygen to the heart muscle, which is one of the most common causes of angina.
Although angina is not a heart attack , it does signal a high risk of having a heart attack . You need medical help right away if you experience chest pain or discomfort.
There are two main types of angina, stable and unstable. Stable angina, which is the most common angina, is common during physical activity and usually lasts for a short time (about five minutes or less) if physical activity has ended. Unstable angina is less common and usually occurs during rest. Unstable angina usually lasts longer and symptoms can be more severe.
Symptoms of angina you may experience, including:
Chest pain or discomfort, such as tightness in the chest Discomfort in the jaw, neck, arms, upper abdomen, shoulders or back Fatigue Sweating Nausea Dizziness There are many risk factors associated with angina, such as high blood pressure, diabetes, obesity, family history, tobacco use, stress, and age.

2. CT scan, MRI and different forms of assessment in angina assessment

To diagnose the cause and evaluate angina, the following tests may be performed:
Electrocardiogram (ECG): This test records the electrical activity of the heart, used to diagnose abnormalities of the heart as arrhythmia or indicating ischemia (lack of oxygen and blood) to the heart. Cardiac activity assessment without images: This heart monitoring test is used to help evaluate how well the heart is working. During a stress test, you'll usually be asked to do physical exercises, like walking on a treadmill. ECG is recorded during exercise. An ECG is used by your doctor to assess whether your heart is getting to the right heart rate and if there are any changes that indicate decreased blood flow to your heart. If you are unable to exercise, medications that have a similar effect on the heart's response to exercise can be used. Blood tests: Blood tests can identify certain enzymes like troponin that leak into your bloodstream after your heart has had severe angina or a heart attack. Blood tests can also identify elevated cholesterol, LDL, and triglycerides that put you at higher risk of coronary heart disease and thus angina. In addition, the following imaging tests may be done:
Chest X-ray: This noninvasive imaging test helps the doctor rule out other causes of chest pain such as pneumonia. Chest CT: A chest CT is a more sensitive test than a chest X-ray that can identify other causes of chest pain such as aortic disease or blood clots in the blood vessels of the lungs. This imaging test combines special X-ray equipment with sophisticated computers to create multiple images of the chest and heart. Coronary computed tomography (CT) scan: This test evaluates the coronary arteries (blood vessels that supply blood and oxygen to the heart) to determine how narrow the arteries are due to plaque without the need for a catheter invade through the arteries into the heart. Contrast material is injected through a small line in an arm vein, similar to that used to draw blood.

Magnetic resonance imaging (MRI): The main purpose of this test is to determine if there is good blood flow to the heart muscle. If there are areas of reduced blood flow, this may indicate plaque with narrowing of the blood vessels. This blood flow assessment may be performed twice during the examination with the use of contrast material. The first can be done after taking medication, which puts stress on the heart like exercise. The second will be performed at rest. Performing an assessment of both stress and rest helps determine if decreased blood flow occurs only with exercise. This method can also assess the function of the heart and determine if there is any scarring in the heart muscle. An MRI machine uses a strong magnetic field, radio waves, and a computer to create detailed images Catheter angiography: In this invasive imaging test, a long, thin plastic tube, called a tube, is used. catheter, which is inserted into an artery in your groin or arm with a needle. The catheter is guided with a wire into the coronary artery and used to inject contrast material directly into the coronary artery to determine if there is any narrowing of the blood vessels. An image of the contrast material in the blood vessels is taken with X-rays. Narrow sections of the vessel can be reopened with a balloon or stent. Echocardiogram: In this test, a transducer that produces high-frequency sound waves is used to create moving pictures of the heart. Heart movement is assessed. If there is reduced movement in part of the heart wall, this may indicate decreased blood flow due to narrowing of the coronary arteries. Imaging may also be done with a pharmaceutical agent that puts stress on the heart to detect reduced movement in a part of the heart muscle that is stressed. Single-emission computed tomography of the heart muscle (SPECT): with this method, the patient is usually asked to do some type of physical exercise such as walking on a treadmill. If the patient is unable to perform exercise for any reason, medications that mimic the heart's response to exercise may be used. A radioactive tracer will be injected into the bloodstream during peak exercise and images of the heart will be taken. The radioactive tracer flows with the blood and will show if any areas of the heart have decreased blood flow.

3. Treatment of angina

Your doctor will recommend healthy lifestyle choices like maintaining a healthy weight, eating a balanced low-fat diet, stopping tobacco products, and finding ways to reduce stress.
In addition, you may also be treated with certain drugs such as:
Medicines such as aspirin, statins, beta blockers, calcium channel blockers or nitrates. Angioplasty and vascular stenting: In applicable cases, after appropriate testing, the physician may perform angioplasty and stenting. This procedure is done to open up blockages in a coronary artery and improve blood flow to the heart. Coronary artery bypass surgery (CABG): This surgery increases blood flow to the heart by using a vein or artery from elsewhere in the body to redirect blood flow around an area of ​​narrowing or blockage in the heart. coronary arteries of the heart. To diagnose and evaluate angina, your doctor may perform an electrocardiogram (ECG), which evaluates your heart's activity without imaging or blood tests to help diagnose your condition.

In addition, chest X-ray, chest CT, coronary CT angiography, cardiac MRI, coronary angiography, echocardiography combined with imaging may be performed. Your doctor may recommend a healthy lifestyle in addition to other treatment options, such as medication, surgery, or angioplasty and stenting.
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Reference article source: radiologyinfo.org