Angina (cont.)

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Angioplasty and coronary artery bypass surgery

When patients continue to have angina despite maximally tolerated combinations of nitroglycerin medications, beta blockers, and calcium channel blockers, cardiac catheterization with coronary arteriography is indicated. Depending on the location and severity of the disease in the coronary arteries, patients can be referred for balloon angioplasty (percutaneous transluminal coronary angioplasty or PTCA with or without stents) or coronary artery bypass graft surgery (CABG) to increase coronary artery blood flow.

What are other methods are used to evaluate angina?

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CT scan calcium scoring is highly accurate in detecting small amounts of calcium in the plaque of coronary arteries. If a CT scan shows no calcium in the arteries, atherosclerotic coronary artery disease is unlikely. Ultrafast CT scanning is useful in evaluating chest pain in younger patients (men under 40 and women under 50 years old). Since young people do not normally have significant coronary artery plaque, a negative calcium score makes the diagnosis of coronary artery disease unlikely. However, finding calcium by this method is less meaningful in older patients who are likely to have mild plaquing simply from the aging process.

Even though a calcium score is useful in detecting calcium in plaque, it cannot determine whether the calcium-laden plaque actually causes artery narrowing and reduces blood flow. For example, a patient with a densely calcified plaque causing minimal or no artery narrowing will have a strongly positive CT scan, but a normal exercise treadmill test. In most patients who are suspected of having angina due to coronary artery disease, an exercise treadmill study is usually the first step in determining whether any plaque is clinically significant. Newer very high speed CT scanners can actually detect true coronary artery plaques and lesions similar to coronary angiography.

Magnetic resonance imaging (MRI), using magnetism and radio waves, can be used to image (produce a likeness of) the blood vessels. Larger vessels, such as the carotid arteries in the neck, can be imaged using this technique. Future software and hardware improvements may allow screening of the heart's arteries with magnetic resonance testing.

Medically Reviewed by a Doctor on 5/10/2012

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Angina - Diagnosis Question: How was the diagnosis of your angina established?
Angina - Share Your Experience Question: Please describe your experience with angina.
Angina - Symptoms Question: What were the symptoms associated with your angina?
Angina - Causes Question: If known, what was the cause of your angina?
Angina - Other Chest Pain Experience Question: Please describe your experience with chest pain that was due to causes other than angina.
Angina - Treatment Question: What kinds of treatment, procedures, or medication did you receive for angina?
Angina- Medications Question: What medications were you prescribed to treat your angina? Describe the side effects.
Angina - Surgery Experience Question: Please describe your experience with angioplasty and coronary artery bypass surgery.
Angina - Calcium Scoring Question: Have you had CT scan calcium tests? Please share your experience, including results.

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