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Best test for early detection of plaque in coronary arteries
Doctor Michael Wong has found that the best way to assess whether and to what extent a person suffers from plaque in the arteries is the electron-beam CT test. There is agreement among the thought leaders in preventive cardiology that this is the best test to measure risk of a heart attack.
Diagnostic Tests
- EKG (electrocardiogram)
- Ultrasound tests
carotid ultrasound
echocardiogram
stress echocardiogram
abdominal aorta - Holter monitor (24 hour EKG)
- Treadmill tests without the echo
- Ankle brachial index for peripheral arterial disease
- ABP blood pressure to measure blood-pressure spikes and help determine medication dosage
arterial lower extremities
venous lower extremities.
Dr. Michael J. Wong
Board certified in Internal Medicine and Clinical Lipidology, Dr. Michael J. Wong is a Los Angeles-based cardiologist specializing in the detection, prevention, and treatment of heart disease, heart attack and stroke. A graduate of Stanford University, he received his M.D. at George Washington University Medical School. He served as Assistant Clinical Professor at UCLA from 1982-1986 & 1996-2007. Dr. Wong did his military service as a cardiologist at the US Air Force Academy at Colorado Springs, CO, where he pioneered the use of treadmill stress testing to measure heart efficiency. In January 2013 Dr. Wong was certified to be one of six physicians in Los Angeles eligible to prescribe the new pharmaceutical Juxtapid (lomitapide) for patients suffering from extremely high cholesterol, unresponsive to statin therapy. The condition is called hypercholesterolemia. Dr. Wong is currently accepting new patients. Please call (213) 483-7766 for appointments.
How We Work
Heart disease (which can lead to a heart attack or stroke) is the number-one killer of both men and women in the United States, accounting for almost 30 percent of all American deaths. But heart disease doesn’t give obvious clues. In fact, most people don’t know they have heart disease until they have their first heart attack. At HeartCare, we specialize in diagnosing your unique personal condition, and from that, developing a customized plan of action to prevent future heart attack or stroke. We begin by seeking answers in your own blood. Advanced lipid (blood) testing may find heart attack and stroke risks undetectable by traditional tests. Then we compare our findings against your current diet, medications, and lifestyle and recommend specific changes to improve your condition.
What & How We Treat
Disease States
Angina
Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. Angina is a symptom of a condition called myocardial ischemia. It occurs when the heart muscle (myocardium) doesn't get as much blood (hence as much oxygen) as it needs. This usually happens because one or more of the heart's arteries (blood vessels that supply blood to the heart muscle) is narrowed or blocked. Insufficient blood supply is called ischemia.
Aortic Aneurysm
An aortic aneurysm is a bulge in a section of the aorta, the body's main artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is stretched and weakened, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death.
Aneurysms can form in any section of the aorta, but they are common in the belly area (abdominal aortic aneurysm) and upper body (thoracic aortic aneurysm).
Atherosclerosis
Atherosclerosis (ath"er-o-skleh-RO'sis) comes from the Greek words athero (meaning gruel or paste) and sclerosis (hardness). It's the name of the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque.
Cardiovascular Disease
Cardiovascular disease includes a number of conditions affecting the structures or function of the heart. They can include: coronary artery disease (including heart attack); abnormal heart rhythms/arrythmias, heart failure, heart valve disease, congenital heart disease, cardiomyopathy, pericardial disease, aorta disease and vascular disease.
Coronary Artery Disease
Coronary artery disease is atherosclerosis of the coronary arteries. Atherosclerosis occurs when the arteries become clogged and narrowed, and this can restrict blood flow to the heart. Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly.
Heart Attack
A heart attack, or myocardial infarction (MI) is permanent damage to the heart muscle. "Myo" means muscle, "cardial" refers to the heart and "infarction" means death of tissue due to lack of blood supply. The heart muscle requires a constant supply of oxygen-rich blood to nourish it. The coronary arteries provide the heart with this critical blood supply. If you have heart disease, those arteries become narrow with plaque and blood cannot flow as well as it should. When the plaque's hard, outer shell cracks (plaque rupture), platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. If a blood clot totally blocks the artery, the heart muscle becomes "starved" for oxygen. Within a short time, death of heart muscle cells occurs, causing permanent damage. This is called a myocardial infarction (MI), or heart attack.
Metabolic Syndrome
Metabolic syndrome is a group of health problems that include too much fat around the waist, elevated blood pressure, high triglycerides, elevated blood sugar, and low HDL cholesterol. Together, this group of health problems increases your risk of heart attack, stroke, and diabetes. Metabolic syndrome is caused by an unhealthy lifestyle that includes eating too many calories, being inactive, and gaining weight, particularly around your waist.
Plaque
Atherosclerotic plaque is a waxy substance formed inside the arteries that supply blood to your heart. This substance, called plaque, is made of cholesterol, fatty compounds, calcium, and a blood-clotting material called fibrin. Doctors have found that there are two kinds of plaque: hard (calcified) and soft.
Most people know about hard plaque and how it can cause a heart attack. If hard plaque builds up in the arteries that supply blood to your heart, the blood flow slows or stops. This decreases the amount of oxygen that gets to the heart, which can lead to a heart attack.
But doctors have now found that even though some heart attacks are caused by hard plaque, most heart attacks are caused by soft or vulnerable plaque. A vulnerable plaque is an inflamed part of an artery that can burst. This can lead to the formation of a blood clot, which can lead to heart attack.
In fact, vulnerable plaque may be buried inside the artery wall and may not always bulge out and block the blood flow through the artery. This is why researchers began to look at how inflammation affects the arteries, and if inflammation could lead to a heart attack. What they found was that inflammation leads to the development of "soft" or vulnerable plaque. They also found that vulnerable plaque was more than just debris that clogs an artery, but that it contained different cell types that enhance blood clotting.
Patients with this kind of plaque may not feel symptoms. In the early stages of the process, the change in blood flow may not be detected with standard testing, but researchers are looking at special scanning techniques that may highlight the presence of vulnerable plaque.
Stroke
A stroke occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.
Brain damage can begin within minutes, so it is important to know the symptoms of stroke and act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.
Transient Ischemic Attack (TIA)
A TIA is a "warning stroke" or "mini-stroke" that produces stroke-like symptoms but no lasting damage. TIAs occur when a blood clot temporarily clogs an artery, and part of the brain doesn't get the blood it needs. The symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes. The average is about a minute. Unlike stroke, when a TIA is over, there's no injury to the brain. Recognizing and treating TIAs can reduce your risk of a major stroke.
Risk Factors
Cardiovascular Risk Factors
The major risk factors are well-established. A family history of heart disease is one risk factor. Other risk factors can be controlled. Of these, the main ones are high blood pressure, high cholesterol, diabetes, obesity, smoking, and a sedentary lifestyle. Stress is also believed to raise the risk, and exertion and excitement can act as triggers for an attack.
Men 45 and older and women 55 years and older are at increased risk of heart attack. High levels of estrogen are thought to protect premenopausal women fairly well from heart attack, but the risk increases significantly after menopause.
Cholesterol
Cholesterol is a waxy, fat-like substance made in the liver and found in certain foods, such as food from animals, like dairy products (whole milk and cheese), eggs and meat. The body needs some cholesterol in order to function properly. Its cell walls, or membranes, need cholesterol in order to produce hormones, vitamin D and the bile acids that help to digest fat. But the body needs only a small amount of cholesterol to meet its needs. When too much is present, health problems such as coronary heart disease may develop.
- Low density lipoproteins (LDL): LDL, also called "bad" cholesterol, can cause buildup of plaque on the walls of arteries. The more LDL there is in the blood, the greater the risk of heart disease.
- High density lipoproteins (HDL): HDL, also called "good" cholesterol, helps the body get rid of bad cholesterol in the blood. The higher the level of HDL cholesterol, the better. If your levels of HDL are low, your risk of heart disease increases.
- Triglycerides: Triglycerides are another type of fat that is carried in the blood by very low density lipoproteins. Excess calories, alcohol or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.
Diabetes
About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke.
Diabetes is a disorder of metabolism--the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced (insulin resistance).
The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80 percent of people with type 2 diabetes are overweight.
Family History
Cardiovascular disease can run in families -- if you have a family history of heart disease, you may be at greater risk for heart attack, stroke, and other heart problems. The closer the relative, the greater your heart disease risk. If you have a "first-degree relative" -- that's a mother, father, sister, or brother (or even a son or daughter) who had heart disease at an early age (male relative younger than 55, female relative younger than 65), that increases your risk of developing heart disease. The more family members who have had early heart disease, the greater your risk of developing heart disease.
High Blood Pressure or Hypertension
Blood pressure is the force of blood pushing against blood vessel walls. The heart pumps blood into the arteries (blood vessels), which carry the blood throughout the body. High blood pressure, also called hypertension, is dangerous because it makes the heart work harder to pump blood to the body and it contributes to hardening of the arteries or atherosclerosis and the development of heart failure. There are several categories of blood pressure, including:
- Normal: Less than 120/80
- Prehypertension: 120-139/80-89
- Stage 1 hypertension: 140-159/90-99
- Stage 2 hypertension: 160 and above/100 and above
Smoking
About 30 percent of all deaths from heart disease in the U.S. are directly related to cigarette smoking. Smoking is a major cause of atherosclerosis. Among other things, the nicotine present in smoke causes:
- Decreased oxygen to the heart.
- Increased blood pressure and heart rate.
- Decrease in the good HDL cholesterol.
- Increase in blood clotting.
- Damage to cells that line coronary arteries and other blood vessels, triggering atherosclerosis and heart disease.
Diagnostic Tests
Abdominal Ultrasound
An abdominal ultrasound uses reflected sound waves to produce a picture of the organs and other structures in the upper abdomen. It is often used to detect, measure, or monitor an aneurysm in the aorta. An aneurysm may cause a large, pulsing lump in the abdomen. No radiation is involved.
Carotid Ultrasound
The carotid arteries in the neck can be easily viewed with a risk-free ultrasound test. Atherosclerosis in these arteries suggests a higher risk for heart attacks and strokes. This is because atherosclerosis occurs throughout the body. The ultrasound helps doctors evaluate blood flow and can show blocked or reduced blood flow through narrowing in the major arteries of the neck. No radiation is involved.
CT Coronary Scan
Coronary computed tomography angiography (CTA) is a noninvasive heart imaging test currently undergoing rapid development and evaluation. High-resolution, three-dimensional pictures of the moving heart and great vessels are produced during a coronary CTA to determine if either fatty or calcium deposits (plaques) have built up in the coronary arteries. Before the test, an iodine-containing contrast dye is injected into an IV in the patient's arm to improve the quality of the images. A medication that slows or stabilizes the patient's heart rate may also be given through the IV to improve the imaging results.During the test, which usually takes about 10 minutes, X-rays pass through the body and are picked up by special detectors in the scanner.This kind of scan can also be used to study all parts of the body and is referred to as a whole body scan.
CT Cardiac Scan
Computed tomographycommonly known as a CT scan, combines multiple X-ray images with the aid of a computer to produce cross-sectional views of the body. Cardiac CT is a heart-imaging test that uses CT technology with or without intravenous (IV) contrast (dye) to visualize the heart anatomy, coronary circulation, and great vessels (which include the aorta, pulmonary veins, and arteries). From the CT cardiac scan a calcium score can be derived. That score is another useful indicator for determining risk.
Echocardiogram
An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen. Echo can be used as part of a stress test and with an electrocardiogram (EKG) to help your doctor learn more about your heart. No radiation is involved.
Stress Echo
During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine that makes your heart beat harder and faster. A stress echocardiogram is usually done to find out if you might have decreased blood flow to your heart. No radiation is involved.
Adapted from the WebMD, American Heart Association, Texas Heart Institute