American Medical Association Family Medical Guide - American Medical Association [320]
Echocardiogram
Coronary angiogram
CT scan
A CT (computed tomography) scan is a diagnostic procedure in which you lie on a table as it slides through a ring-shaped machine. Detectors inside the scanning ring send signals to a computer, which constructs cross-sectional X-ray images of the heart and coronary arteries. This test detects calcium deposits in the arteries resulting from atherosclerosis. A faster version of CT scanning (called ultrafast CT or electron beam CT) is used to predict heart attack risk in people who have no symptoms of heart disease.
IMT
IMT (intimal-medial thickness) uses ultrasound (see page 111) to measure the thickness of the carotid arteries and to determine the extent of atherosclerosis. An increase in the thickness of the carotid arteries indicates an increased risk of developing heart disease. This test can detect heart disease before the arteries are significantly narrowed.
ABI
ABI (ankle-brachial index) uses Doppler ultrasound (see page 111) and standard blood pressure cuffs to detect narrowing of the arteries, a strong sign of heart disease. ABI compares the systolic (the first, or upper, number in a blood pressure reading) blood pressure in the ankle to the systolic blood pressure in the arm. A low ratio (less than 0.9) is an indication of heart disease. This test can detect heart disease before the arteries are significantly narrowed.
Treatment
If you have heart disease, your doctor will work with you to develop a treatment program designed to slow the progression of the disease and reduce your risk of developing potentially fatal complications such as a heart attack (see page 567) or heart failure (see page 570). You will probably need to make lifestyle changes such as following a healthy diet (see page 35), losing weight if you are overweight (see page 51), exercising regularly (see page 45), managing stress (see page 55), and quitting smoking if you smoke (see page 29). If you have high blood pressure, your doctor will prescribe antihypertensive medication (see below). If your total blood cholesterol level is elevated, he or she may prescribe a cholesterol-lowering medication (see page 564). Your doctor may also recommend surgery (see page 564) to bypass or clear an obstructed or blocked artery.
Medications for heart disease
If you have heart disease, your doctor may prescribe medication to improve blood flow and relieve your symptoms. You may need to take this medication for the rest of your life. If you experience any unpleasant side effects from the medication, talk to your doctor but keep taking the medication until he or she tells you to stop. Your doctor will probably prescribe another medication that does not cause the side effects. Medications used to treat heart disease include the following:
• Beta blockers Beta blockers interfere with the effects of hormones in the body that normally increase heart rate and blood pressure. Beta blockers reduce the resting heart rate and, during exercise, limit the increase in heart rate, decreasing the body’s demand for oxygen. Beta blockers lower the risk of heart attack and sudden death in people who have heart disease and can significantly reduce the risk of death from heart disease in people who have had a heart attack. The more severe the heart attack, the more benefit these drugs provide. Possible side effects include slow heartbeat, fatigue, or erectile dysfunction (in men).
• Diuretics Diuretic drugs lower blood pressure by causing the kidneys to eliminate more water and sodium from the body, reducing the heart’s workload. Possible side effects include a rash, muscle cramps, fatigue, or erectile dysfunction (in men).
• ACE inhibitors