Why Aren’t CT Heart Scans Done in Emergency Rooms for Chest Pain ?
If you go to the ER for chest pain, you won’t be given a CT scan of your heart just because of your symptom.
And if you do get one, it won’t be to check for a heart attack as the cause of the chest pain.
“There are two types of CT angiogram that could be performed in the ER for chest pain — CT pulmonary angiogram and CT coronary angiogram,” says Resham Mendi, MD, a renowned expert in the field of medical imaging, and the medical director of Bright Light Medical Imaging.
“A CT pulmonary angiogram would be done if the doctor thinks that there is a risk for pulmonary embolism (blood clot in the pulmonary artery). This is frequently done in emergency rooms.”
The doctor may refer to the procedure as just a “CT scan” when speaking to the patient or family member.
However, it requires an injected contrast dye to show the blood vessels.
A kidney test is done to make sure the patient’s kidneys are healthy enough to tolerate the contrast dye.
This imaging study will look at the lungs, not the heart.
A complaint of chest pain will net a blood test called D-dimer which can indicate the presence of a blood clot somewhere in the body.
This is why the pulmonary angiogram is ordered, because a blood clot in the lung can cause chest pain.
D-Dimer Is Negative, so Why Not a CT Angiogram for the Chest Pain?
“A CT coronary angiogram is done to look for blockage in the coronary arteries which could cause a heart attack,” says Dr. Mendi.
“This is not typically done in the ER because of the urgent nature of heart attacks.
“If there is concern for heart attack, they usually do EKG and blood tests in the ER as a quick way to look for abnormalities.
“If more evaluation is needed, they would rather do a traditional coronary [catheter] angiogram rather than a CT coronary angiogram.
“This is because during a traditional coronary angiogram, if the cardiologist sees a blockage, they can open it up right away while they are looking at it. This cannot be done in a CT coronary angiogram.”
The traditional or catheter angiogram carries a risk of stroke and heart attack, though these complications are rare.
Nevertheless, due to these risks, this gold-standard procedure is reserved for patients whom doctors are pretty convinced have serious blockages.
If the blockage can be treated with a stent, the stent placement can be done right on the spot during the catheter procedure.
The doctor may also determine that bypass surgery is the only viable treatment. The patient may then be prepped on the spot for emergent surgery.
You can now see how a CT angiogram would be an extra, burdensome step that would potentially delay things – which is why currently, it’s not a routine procedure in the ER to evaluate chest pain – especially in patients at low risk for coronary artery disease.
Dr. Mendi has published several articles in radiology journals and has expertise in MRI, women’s imaging, musculoskeletal, neurological and body imaging.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Fruit Eating Guidelines for Diabetics
The sugar in fruit can add up fast, so just how much fruit can people with diabetes eat at one sitting and also in one day?
Diabetics should not give up fruit just because it contains sugar. (more…)
How Does a Dentist Screen for Oral Cancer?
There are several types of cancer that can occur in the oral cavity and all of them pose a serious risk. (more…)
Why Don’t All People with Cardiorenal Syndrome Get Drug Treatment?
What contraindicates drug treatment in cardiorenal syndrome if the only drugs that can reverse the condition—or at least—extend survival, might cause further kidney injury? (more…)
How Much GERD Causes Barrett’s Esophagus?
How much acid reflux must you have in order to cause Barrett’s esophagus, a precancerous condition in the “food pipe” that’s a risk factor for esophageal cancer?
If a person suffers from acid reflux symptoms every day, is this enough to cause Barrett’s esophagus after a certain length of time?
Is it a type of symptom that’s more relevant to the development of Barrett’s, such as heartburn as opposed to coughing?
Does the severity of the GERD symptoms play into this?
In short, should people have anxiety over developing Barrett’s esophagus just because they have GERD or episodes of acid reflux?
Symptoms of Acid Reflux
• A burning or aching in the chest and/or upper abdomen
• Coughing, which may be present only overnight
• Waking with an odd taste in the mouth. The taste may also be triggered by exercise like running, step aerobics or jumping.
• A burning or lump feeling in the throat
• Sensation of difficulty swallowing
“We know that Barrett’s esophagus is due to chronic exposure of the esophagus to acid and stomach contents,” says Alan Gingold, DO, a board certified gastroenterologist with Central Jersey Ambulatory Surgical Center.
“Typically, five years or more of reflux is considered the minimal amount of time that it takes for patients to develop Barrett’s in the setting of chronic reflux.
“Obviously this is an average, and so there are patients who have less than five years’ exposure and develop Barrett’s, and there are patients with many more than five years and never develop Barrett’s.
“Risk factors for Barrett’s include cigarette smoking and other factors such as being a white male, obesity, alcohol use, FH adenocarcinoma of the esophagus.”
There is no research that links a subjective report of severity of a GERD symptom with the likelihood of developing Barrett’s.
For instance, nobody can say that a subjective report of chest pain being “severe” puts the patient at greater risk of Barrett’s than someone who reports their acid reflux chest pain as only “mild.”
Reflux symptoms occurring often throughout the day, has also not been linked to a higher risk of Barrett’s than does having the symptoms only occasionally throughout the day.
Finally, type of symptom has not been found to be linked to any higher risk.
Thus, the person whose GERD causes mostly throat related symptoms is not more or less likely to get Barrett’s than someone whose acid reflux only causes chest or abdominal discomfort, or whose reflux occurs only after eating, or only overnight, or only during anxiety or exercise, etc.
If you’re worried about developing Barrett’s esophagus, then take measures to lower your risk for this precancerous condition:
• Stop smoking
• Avoid drinking
• Lose excess body fat
• Eat fewer processed foods and more fruits and vegetables.
• Replace white flour foods with whole grain versions.
• Replace white rice with brown rice.
If your acid reflux or GERD symptoms are not responding to medication or conservative treatment (e.g., sleeping with torso elevated), or if they are longstanding — see your doctor.
Dr. Gingold attributes his success to the extra time he spends with his patients. His areas of expertise include reflux disease, Barrett’s esophagus, capsule endoscopy, chronic liver disease and inflammatory bowel disease. Dr. Alan Gingold is board certified by the American Board of Internal Medicine in Gastroenterology
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: ©Lorra Garrick
Sleep Apnea: How a Dentist Can Help You Get Real Rest at Night
Sometimes a dentist can create a perfect solution to a patient’s obstructive sleep apnea.
Many people wonder if they have obstructive sleep apnea, especially if they never feel recharged from sleeping or wake up in the middle of the night feeling choked.
Sleep apnea, which is usually but not always associated with snoring, is a serious condition that requires prompt treatment.
Are You Fed Up with CPAP?
Although CPAP machines are the most common method of sleep apnea treatment, many people find CPAP intolerable.
• It’s uncomfortable (e.g., air pressure, mask fit, skin irritation).
• The apparatus may shift during sleep.
• It can result in morning dry mouth.
• Vigilent cleaning of the device is required.
How a Dentist Can Help with Sleep Apnea
If you’re tired of the CPAP machine, there is a possible alternative.
A dentist can create an oral appliance similar to a sports mouth guard.
The mandibular advancement device (MAD) fits in your mouth and does not need to be hooked up to anything else.
Oral appliance
Each oral appliance is custom-fitted to maximize your comfort and breathing during sleep. They are also easy to care for.
Another excellent feature of the dental appliance is that it’s easy to take on trips. Its compact size lets you take it anywhere, ensuring that you get a good night’s sleep.
Another advantage is that they do not make any noise, leaving your partner undisturbed.
More on Mandibular Advancement Devices
These are not recommended for moderate or severe sleep apnea, but some patients with a diagnosis of mild sleep apnea may benefit.
The confirmation of benefit could only come from a sleep study when the patient is wearing the MAD. If the study’s results show an apnea-hypopnea index at under five per hour, this means the oral appliance is working.
More than 100 types of these stop-snoring devices have been approved by the FDA. Many insurance plans will also cover them, but you will need to have an official medical diagnosis of sleep apnea.
Many people who get an oral appliance from a dentist find that their sleep is so much better – even on the first night. Just as important is the fact that with better sleep, you’re positively moving towards better health.
Dr. Vadivel, DDS, is a board certified periodontal surgeon, and Founder-CEO of Implants & Gumcare of Texas, offering affordable restorative and cosmetic dental procedures. Dr. Vadivel has over 25 years of experience.
What Does Burping After Heart Bypass Surgery Mean?
No, not the burping you might do immediately after coronary bypass surgery, but in the days or weeks after the operation?
Can an Ultrasound Show Hard, Calcified Plaque in the Heart’s Arteries ?
An ultrasound takes “pictures” of your heart.
The difference between hard calcified plaque and soft plaque in the coronary arteries is that the hard buildup is much more stable. (more…)
Should an IVC Be Placed in Every Joint Replacement Patient?
Since joint replacement surgery raises the risk of DVT, why don’t all joint replacement surgeries include IVC filter placement, especially in higher-risk patients?
It seems that it would make sense to perform the 20 minute procedure on a pre-emptive or prophylactic level, especially for patients with the greatest risk for a deep vein thrombosis (e.g., advanced age, smoking history, obesity).
An IVC filter can prevent a DVT from getting into the lungs where it can become quickly fatal as a pulmonary embolism. There’s no telling when a deep vein thrombosis might become dislodged and travel to the lungs.
An IVC placement is non-invasive.
Another question is why, once a DVT is actually diagnosed, the inferior vena cava filter isn’t automatically placed.
A pulmonary embolism is a leading cause of cardiac arrest. Death can result within minutes of the DVT breaking off from its original location.
If the pulmonary embolism is big enough, it’ll prevent air from getting into the lungs. The patient will essentially suffocate.
“Current evidence does not support routine filters in patients,” says Henry Boucher, MD, clinical instructor of Adult Reconstruction, Medstar Union Memorial Orthopaedics, Baltimore, MD.
“It is true that they can be placed less invasively, but they are not without potential complications—vascular injury, migration, post-thromboembolic issues such as leg swelling and pain,” he continues.
“Some higher risk patients may be candidates for a filter—prior PE and intolerance to anticoagulants—but this would be up to discretion of the surgeon and a vascular consultation.”
Wouldn’t the pros outweigh the cons?
After all, it’s estimated that a quarter of a million Americans die every year from a pulmonary embolism (some estimates go up to 300,000 and more), and though many of these deaths are from non-surgically related PEs (i.e., air travel), many are complications from joint replacement surgery.
“Filters for all patients would be a huge expense to prevent a complication that typically happens less than one percent of the time after joint replacement surgery,” says Dr. Boucher.
One percent sounds insignificant, but the large death toll can be attributed to the number of hip and knee replacements done every year in the U.S.
According to the American Academy of Orthopaedic Surgeons, over 800,000 hip and knee replacements were performed in 2003. Currently that number exceeds 900,000.
“Most DVTs are treatable without progression to pulmonary embolism.
“Most lower leg DVTs are not a problem; we worry much more about ones behind the knee and in the thigh.”
Dr. Boucher’s specialties are hip and knee surgery, replacement and revision, and sports medicine surgery. He has been the recipient of the Golden Apple Award for teaching excellence multiple times.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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