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COVER STORY: HEART ATTACKS
Detection: The Breakthroughs
With cutting-edge technology,
the presence of coronary artery disease can be determined at a very early
stage
To discover coronary
artery disease after chest pains is like discovering pregnancy at the
time of labour pains, says cardiac surgeon Naresh Trehan. But most Indians
only realise they may have heart problems when the disease has developed
to full blown clogged arteries. At that stage one in every five patients
dies, no matter how good the treatment. The tragedy is that if detected
early, 99 per cent of heart patients can lead a normal healthy life with
only minimal modifications in diet and lifestyle. In the US, early detection
and preventive measures in the past three decades have steadily brought
down mortality rates due to cad by 2-4 per cent per year.
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HEART OF THE MATTER: A patient about to enter an MRI tunnel for
cardiac screening
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A battery of biochemical tests can provide the
initial clues about a patient's potential risk of cad. High levels of
LP(a), homocysteine and a substance called fibrinogen are all possible
red flags for future heart problems. An LP(a) test costs Rs 400. Blood
LP(a) levels of 30 mg/dl or more is bad news. For Rs 550, a fibrinogen
test reveals whether the plasma fibrinogen levels are in the normal range
of 180-350 mg/dl. A test for homocysteine is not cheap at Rs 9,200, but
by displaying whether the amino acid floating in the blood is more than
the normal 2.8-13.5 micromoles, it could be a life-saving marker.
The biochemical tests warn of risks. For early
detection of the actual disease, angiography is considered the "golden
standard." But this test is expensive (Rs 14,000) and invasive, carrying
a 1 in 10,000 chance of mortality. Fortunately, there are now state-of-the
art alternatives to angiography in India-cardiovascular Magnetic Resonance
Imaging (CV-MRI) and ultrafast spiral CT-scan.
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Cardiac Screening With MRI
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# Magnetic resonance
imaging (MRI) is a non-invasive way of detecting blocks in the arteries
much earlier than conventional angiography. The coronary arteries
in the heart can be visualised in an MRI in 3-D, helping to detect
even minimal
blockages.
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Coronary Artery Calcium Scoring
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# The levels of calcium in arteries
is an early signal of susceptibility. A CT-scan (picture) is used
to measure calcium deposits (seen as white threads, extreme right)
and numerical scores given. With this technique heart problems can
be detected at a very early stage.
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CV-MRI allows the coronary arteries to be visualised
and even minute blockages detected. So cad can be detected at an early
stage. But there are disadvantages. Due to its magnetic properties, MRI
can't be used in patients with metallic implants. Besides, on a third
of patients the procedure doesn't show the whole length of arteries.
Ultrafast spiral CT-scan is a quantitative measure
of the development of the disease. Calcium gets deposited where plaques
form in the coronary arteries. This technique measures calcium levels
using act-scan. The larger the plaque, the more the calcium deposit. Calcium
levels are digitally scored. Less than 100 and the patient can heave a
sigh of relief. Scores of 100-400 imply it is time to get worried, while
scores greater than 400 mean danger. At hospitals like Escorts, patients
are screened by a combination of CV-MRI and Ultrafast ct-scan techniques
to provide a comprehensive picture at the cost of Rs 10,000 (Rs 5,000
+ Rs 5,000).
Technology today is more than a match for the
genes that play havoc with Indian hearts. Using technology, and minimally
modulating lifestyles, will be the key to a healthier heart.
-Supriya
Bezbaruah
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