Health

(WCCO) Eight million Americans show up at emergency rooms each year complaining of chest pain. Tests help doctors diagnose any problem spots but sometimes symptoms can't be explained. That's why more patients are being given computerized tomography (CT) angiogram which is a look inside the heart.

Poets aren't the only ones who yearn for a glimpse inside the human heart. Medicine has long tried to get a peek at the inner workings of the organ that keeps our life's blood flowing.

A tread mill stress test reveals much in those wiggly lines. An X-ray angiogram actually allows doctors to see the three main coronary arteries that feed the heart and supply oxygen. But that look around the heart costs about 9,000 to $10,000.

For less than one-fifth the price, patients can get another view with a high-speed CT angiogram.

Methodist Hospital invited WCCO's Dennis Douda to take a look at his ticker with a CT angiogram. But because there is radiation exposure and risks from the medications used, there has to be a legitimate reason for putting Douda through the procedure.

Those reasons for Douda include high cholesterol, high blood pressure controlled by medication and the fact that his grandfathers and uncles died of heart disease.

Cardiologist Soma Sen with Park Nicollet Health Services said CT angiogram is a particularly good way to rule out problems in coronary arteries when a patient's symptoms cannot be explained.

"If somebody is very concerned they have chest pain. They have multiple stress tests which are negative. They have borderline risk factors, like high cholesterol or high blood pressure. If this [test] is normal, then we know they do not have obstructive coronary artery disease," said Dr. Sen.

The process starts with an IV line to administer blood pressure medication to slow the heart slightly. It will later be used to add contrast dye. There will also be a mild dose of nitroglycerin.

"Its a little spray we use underneath your tongue. Two squirts, and it's absorbed under your tongue, and it dilates your coronary arteries. So with a slow heart rate and the bigger arteries they're able to get a good picture," said Rose Bjorlin of Park Nicollet Heart Center.

To minimize radiation exposure, the scanner only takes its images between contractions when the heart is the most still. That's why the heart is slowed, to stretch out the flat lines on the EKG.

A squirt of dye into the bloodstream and the scan is captured with 64 high-speed slices that show up 3-D.

Within 20 minutes the images are reassembled by computers which assign colors to different tissues and give Dr. Sen a lot to look at.

The blue lines she isolates are the lumens or inner channels of each coronary artery. The only trouble spot, the left anterior descending, often called the widow maker because massive heart attacks often start there.

"So that is probably. A little mixed plaque. A little bit of calcium and a little bit of cholesterol plaque too," said Dr. Sen.

She said for serious and immediate heart threats, she still goes straight to a catheter lab for a look.

"If we are worried that somebody has coronary disease, in that case it is better to go for the invasive coronary angioplasty," she said.

However, for a less invasive, far less costly look Dr. Sen favors the CT angiogram.

For Douda, the picture is worth a thousand words. Dr. Sen has no trouble convincing him to stay on his cholesterol medication and to keep eating healthy and exercising. The scan gave him great peace of mind as well.

Medicare announced last month it will cover the CT angiogram under certain circumstances. Private companies usually follow suit when there's a demonstrated need.

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