Detection and Diagnosis of Coronary Artery Disease
It's easy to recognize coronary artery disease after someone suffers a heart attack. It is more challenging to detect it in people who show no signs or symptoms of heart disease.
"The whole paradigm is shifting away from targeting the person who is at the edge of the cliff, and toward identifying the patient well before he reaches that edge," says Jonathan L. Halperin, MD, Professor of Cardiology and Director of Clinical Cardiology Services. "It's not only being able to identify the disease when it is there, but identifying it before it is threatening."
Mount Sinai's top cardiologists use creative, hands-on methods to identify heart disease. Valentin Fuster, MD, PhD, Professor of Cardiology and Director of Mount Sinai Heart, sometimes asks patients in his office to do a series of sit-ups, then listens to their hearts. Dr. Fuster's diagnostic skills, honed by decades of experience, enable him to tell just by hearing the heart's sounds after exertion whether blocked arteries have caused the vessel walls to stiffen.
Mount Sinai Heart has the most advanced diagnostic tools available.
"For every patient, there is an appropriate test." says Annapoorna Kini, MD, Associate Professor of Cardiology and Associate Director of the Mount Sinai Cardiac Catheterization Lab. "If one test is not giving us the answer we're looking for, we always have another, whether it's an angiogram, ultrasound, or checking the pressure gradient in the arteries. We have everything we need right here in the cath lab to give patients the answers they need."
Assessing Your Heart Disease Risk
A thorough physical examination is the first step in any comprehensive heart health assessment. But at some point, physicians may need to peer inside your body. Mount Sinai Heart physicians are experts at administering the appropriate diagnostic tests.
Diagnostic tests can:
- Confirm a diagnosis
- Predict long-term outcomes
- Identify patterns of disease associated with an adverse prognosis
- Identify patients who might benefit from more aggressive interventions
- Judge the risk of cardiac events
Assessing a patient at risk of coronary artery disease depends on his or her health, age, and significantly, gender.
"We have the best technologies to identify early heart disease in both men and women," says Mary Ann McLaughlin, MD, Associate Professor of Cardiology and Director of the Women's Cardiac Assessment and Risk Evaluation Program.
Since many women experience heart disease symptoms differently from men, Mount Sinai's diagnostic equipment forms an indispensable part of Dr. McLaughlin's tool kit.
Technologies Used to Diagnose Coronary Artery Disease
Mount Sinai Heart has an arsenal of cutting-edge diagnostic tools at our disposal.
Newer imaging technologies include:
- Computed tomography (CT) angiography: Provides 3-D imaging of the major blood vessels of the heart
- Cardiac magnetic resonance (CMR): Delivers detailed images without using radiation
- Diagnostic catheterization: Provides angiogram X-ray images to assess coronary artery disease by using a catheter threaded from a blood vessel into the heart
- Intravascular ultrasound (IVUS): Measures blood flow to determine which type of angioplasty should be used
Traditional imaging technologies include:
- Exercise stress testing: Patients exercise on a treadmill while clinicians monitor their hearts
- Nuclear stress testing: Combines exercise or medical stress testing with nuclear images of blood flow to the heart, improving the accuracy of coronary disease detection as compared with conventional stress testing
- Calcium scoring: Tests for hard plaque build-up in artery walls
- Echocardiography: Uses sound to form a moving picture of the heart — can be combined with stress testing (stress echocardiography) for detection of coronary disease
Technologies on the Forefront
When it comes to the adoption of new technologies, Mount Sinai is unique not just in New York, but nationwide: we are the first institution in the United States to install the newest generation of nuclear cardiology cameras for clinical use. This technology offers increased speed of imaging, decreased radiation dose, and potential for new applications, such as measurement of coronary flow.
Milena Henzlova, MD, PhD, Professor of Medicine and Director of the Nuclear Cardiology Laboratory, welcomes this innovation. "I believe that the new technology will improve patient safety, comfort, and accuracy of diagnosis," she says.
For patients with a history of heart attack, Mount Sinai Heart doctors are using newer echocardiographic techniques to assess the impact of coronary disease on heart function. Stress echocardiography is a safe, quick, and accurate way of testing patients for coronary artery disease. The use of a high contrast agent in selected patients means a greater chance of getting an accurate test result, even in patients not considered good candidates for this test at other institutions.
"Mount Sinai Heart uses sophisticated imaging techniques that do not exist anywhere else in the world," says Zahi A. Fayad, PhD, Professor of Cardiology and Director of the Translational and Molecular Imaging Institute.
Under Dr. Fayad's direction, for the first time at any hospital, a magnetic resonance imaging (MRI) machine will be paired with a positron emission tomography (PET) scanner in the same room. Dr. Fayad is excited by the possibilities, explaining, "Because the MRI has a great resolution, we can see things in three dimensions. We are going beyond anatomy to see signs of sickness on the cellular level."