Chest Pain & Angina

Coronary artery disease is the disease of heart blood vessels that leads to fatty deposits to form on the vessel walls. These deposits, called plaques, can grow and grow until the vessel narrows. If the blood vessel narros to the point that the heart muscle does not get enough blood, one can experience chest pain also known as angina.

Most chest pain is not related to the heart, even so you should not take any chances. If you are having chest pain, call 9-1-1 immediately.

In stable symptoms, we can help evaluate whether the chest discomfort might be related to a heart artery blockage. The best way to distinguish is through the following:

– Talking to you. Your description of symptoms is absolutely crucial in the evaluation. A complete history and physical exam is necessary in the evaluation – Stress testing. There are different types of stress test that can be used to indirectly identify major heart artery blockages. Either through exercising on a treadmill or a “chemical” stress test, we can identify if the heart is getting enough blood. – Echocardiogram. This painless non-invasive imaging test uses ultrasound to visualize the heart chambers, the heart function, and the valve function. – Coronary angiogram. Also known as a “heart cath”, this is a minimally invasive procedure to directly visualize the arteries of the heart for any blockages. Special x-ray pictures are taken to identify major blockages.

During a heart cath, other diagnostic and therapeutic steps can be taken:

a) Fractional flow reserve (FFR). In order to determine if a blockage is “tight enough” to cause flow problems, FFR is a test that can be performed to give the answer. A special wire is carefully placed pass the heart artery blockage to measure a pressure difference across the lesion when certain medications are given.
b) Intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT). We now have the ability to further evaluate a heart artery blockage. With these two technologies, we can “see” the artery from the inside providing us with invaluable information about calcium deposits, fat deposits, lesion size and length.
c) Coronary angioplasty and stenting. If a heart artery blockage is found to be “tight”, our doctors have the training and skills to improve the blockages using special balloon and mesh-like metal stents. These procesures, also known as percutaneous coronary interventions (PCI), can restore blood flow to the heart muscle and relieve angina

d) Coronary atherectomy. With severe heart blockages, a ballon inflation might not be enough. Artery plaques can sometimes consist of heavy calcium deposits that wont yield to balloon inflations. Our physicians are pioneers in techniques to modify the heart artery plaques (known as atherectomy), to make PCI a success.

If heart blockages are found to be severe, a bypass surgery might be recommended. Our physicians work closely with some of the most skilled cardiac surgeons in the country. Together, the surgeon and cardiologist can decide the best strategy to fix the heart blockages, whether a bypass surgery, heart stents, or sometimes a combination of both! A newly emerging technique known as a “hybrid” procedure combines the benefit of both bypass and stenting in a minimally invasive procedure.