Cardiology is the medical specialty focused on the heart and the cardiovascular system. It involves the diagnosis, treatment, and prevention of conditions affecting the heart and blood vessels. These conditions include coronary artery disease, heart failure, arrhythmias (irregular heartbeats), and valve disorders. The field covers a broad spectrum, from congenital heart defects present at birth to acquired conditions like heart attacks.
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Before a doctor recommends a stent, they must gather definitive proof that an artery is blocked and that the blockage is severe enough to restrict blood flow. This diagnostic process is a journey that moves from simple conversations to advanced imaging. It is designed to filter out other causes of chest pain, such as acid reflux or muscle strain, and hone in on the heart’s plumbing.
The decision to place a stent is based on anatomy and function. Anatomy refers to what the blockage looks like—where it is and how tight it is. “Function” refers to how the blockage affects the heart—is it starving the muscle of oxygen? Doctors use a suite of tests to answer these questions. Understanding this sequence helps patients see the logic behind the referral to the catheterization lab.
The first step is always a thorough evaluation in the doctor’s office. Your doctor will ask detailed questions about your symptoms: When does the pain start? Does it stop when you rest? Does it spread to your arm? They will also review your risk factors, such as smoking history, diabetes, and family history. This information helps them calculate your pre-test probability of having heart disease.
During the physical exam, the doctor listens to your heart and lungs. They are listening for irregular rhythms or sounds that suggest the heart is straining. They check your blood pressure and feel the pulses in your wrists and feet. Weak pulses in the legs can be a clue that arteries all over the body, including the heart, are narrowed by plaque.
An electrocardiogram, commonly called an ECG or EKG, is usually the first test ordered. It is a quick, painless snapshot of the heart’s electrical activity. Sticky patches (electrodes) are placed on your chest, arms, and legs to record the electrical signals that trigger your heartbeats.
An ECG can show if you have had a heart attack in the past or if your heart is currently deprived of oxygen (ischemia). It looks for specific changes in the wave patterns on the graph. However, a resting ECG can often look completely normal even in a person with serious blockages, because the heart might be getting enough blood while you are sitting still. That is why further testing is usually needed.
To find a blockage, doctors often need to see how the heart performs under pressure. This is the purpose of a stress test. The goal of the stress test is to make the heart beat faster and harder to determine if the arteries can keep up with the increased demand for blood. The most common type is the exercise stress test, where you walk on a treadmill while hooked up to a heart monitor. The speed and incline increase gradually.
If you cannot exercise due to arthritis or other issues, a chemical stress test is used. You receive a medication through an IV that mimics the effect of exercise by dilating blood vessels or making the heart beat faster. Doctors watch for chest pain, shortness of breath, or changes on the ECG monitor that indicate a part of the heart is starving for flow.
This is the standard treadmill test. It measures your physical capacity. If you have to stop early because of chest pain or if your blood pressure drops, it is a strong sign of blockage.
This combines the stress test with imaging. A tiny amount of safe radioactive tracer is injected. A special camera takes pictures of blood flow to the heart muscle at rest and during stress. If a spot on the heart is dark (no tracer) during stress, it means the area is blocked.
An echocardiogram is an ultrasound of the heart. It uses sound waves to create a moving picture of the heart beating. It allows doctors to see the walls of the heart pumping. If a major artery is blocked, the section of muscle it supplies might stop moving or move weakly compared to the rest of the heart. This is called a “wall motion abnormality.”
Echocardiograms are noninvasive and use no radiation. They are excellent for checking the overall pumping strength of the heart (ejection fraction) and ensuring the heart valves are working correctly. While an echo cannot see the arteries directly, it shows the functional consequences of a blockage.
If the non-invasive tests suggest a blockage, the definitive test is coronary angiography. This is an invasive procedure performed in a hospital catheterization lab. It is the only test that allows the doctor to see the arteries directly and measure the blockages precisely.
A long, thin tube (catheter) is inserted into an artery in the wrist or groin and guided up to the heart. Contrast dye containing iodine is injected through the catheter. This dye shows up clearly on X-ray video. As the dye flows through the coronary arteries, it creates a roadmap. Healthy arteries look like smooth, wide rivers. Blocked arteries look like hourglasses—pinched and narrow. This test tells the doctor exactly where the stent needs to go.
Not every blockage needs a stent. This is a crucial concept for patients to understand. Doctors generally use a threshold to decide. If an artery is less than 70% blocked, it often does not cause symptoms because enough blood can still squeeze by. These blockages are usually treated with medication.
If a blockage is more than 70% and is causing symptoms, or if special pressure-wire tests (FFR) done during the angiogram show that blood flow is significantly restricted, then a stent is recommended. The goal is to treat the patient, not just the picture. A stent is placed to relieve symptoms or save heart muscle, not just to improve the X-ray look.
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For most people, yes. However, the contrast dye contains iodine, which can be hard on the kidneys. Doctors will check your kidney function with a blood test beforehand. If you have kidney issues, they will give you extra fluids to help flush the dye out quickly.
Yes, a Coronary CT Angiogram (CCTA) is a sophisticated X-ray scan that can see the arteries non-invasively. It is excellent for ruling out disease. However, if it finds a blockage, you will still need the invasive catheter procedure to fix it, which is why high-risk patients often skip the CT and go straight to the cath lab.
Yes, you are typically awake but sedated. You receive “twilight sedation,” which makes you very relaxed and sleepy, but you can still follow instructions like “take a deep breath.” You will not feel the catheter moving inside your body.
Non-invasive tests like echoes and stress tests take about an hour. The diagnostic angiogram usually takes 20 to 30 minutes. If a blockage is found and a stent is placed immediately, the procedure may take an additional 30 to 60 minutes.
Doctors check your blood to ensure your kidneys are healthy enough for the dye and that your blood clotting ability is normal. Since the procedure involves entering an artery, preventing excessive bleeding is a top safety priority.
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