Heart disease may manifest without warning

Although risk factors like diabetes, smoking and high blood pressure clearly greatly increase a person's chance of developing heart disease, a lack of identified risk factors is not a guarantee against the disease.

"The risk factors in general work well," Dr. Brent Wilson said during the Deseret Morning News/Intermountain Healthcare Hotline Saturday. "But we still see people who with no warning drop dead (from heart disease) or for whom a heart attack is the first sign of problems."

Wilson and Dr. Christopher McGann, both advanced diagnostic cardiologists at LDS Hospital's Cardiac Imaging Center, fielded dozens of calls while many callers waited patiently for long periods of time during the hotline, which focused primarily on new technologies that take much of the guesswork out of diagnosing heart disease.

Callers ranged from the worried but hopefully well to people who have been diagnosed with heart disease and were looking for more information.

Which test and when it should be done is something that has to be decided individually by physician and patient, taking into account family history, risk factors and symptoms, if there are any, McGann said. Physicians also weigh the potential value against any risk posed because CT (computed tomography) tests expose patients to some radiation.

A coronary calcium score is a quick test using cardiac CT to look for coronary calcium. Its presence "is definitive," they said, for coronary artery disease and calcium deposits may begin showing up years before symptoms would appear — in time to stop smoking, increase exercise, change dietary habits and begin taking medications to slow down the progression of disease.

Coronary CT angiography is a noninvasive way to look at the vessel lumen and vessel wall to identify early heart disease. But it's not just for prevention. The test may be valuable in cases where heart disease is already known.

The cardiac MRI uses radio frequency signals (no radiation) to create images of heart muscle, blood flow and heart valves. The technology can show heart function, identify a mass or clot in the heart, look at scar tissue that might indicate a previous heart attack and more. It also can be a stress study that identifies blockages in coronary arteries that can result in heart attacks. Depending on what's needed, it can be a stress, function or anatomy study or a combination.

That test is not usually used for people who have pacemakers or implanted defibrillators because the magnet may interfere with the device.

But there are other tests, including the traditional nuclear studies and echocardiograms, that can be used. "They all have their place," Wilson said.

For instance, for people who have already had stents placed, MRI offers a better picture of what's happening. The stent's material can create an artifact or be harder to see inside with a CT scan.

Several callers were surprised to hear that all of those tests are available at LDS Hospital, believing all the major services moved to the new Intermountain Medical Center recently. But McGann and Wilson assured them that the hospital continues to offer many advanced-care and diagnostic services in various specialties.

Intermountain and the Deseret Morning News team up to tackle a different health topic the second Saturday of each month.

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E-mail: lois@desnews.com