Executive Summary

Introduction

The Noninvasive Heart Center specializes in seeing patients who have been told they must have angiograms, angioplasty, or bypass surgery because their coronary arteries are blocked due to coronary artery disease. Such patients usually have been told surgery must be carried out immediately, there are no other options for treatment, and that medical treatment with drugs will not work. None of this is true. Medical treatment not only can increase the blood flow to the heart muscle, and reduce the workload of the heart, but actually will prevent future heart attacks, and increase survival compared to angioplasty or bypass surgery. Surgery is rarely necessary, and even when necessary, never needs to be carried out immediately.

For patients who have already had angiograms, and have been told their arteries are blocked, they should be aware that angiograms cannot image the small arteries that make up the heart's microcirculation. An artery may appear to be obstructed, but the muscle it goes to often functions normally, and is in no danger because its blood supply comes from the microcirculation or from collateral vessels too small to be imaged by the angiographic technique.

By using noninvasive tests we can determine if the blood supply to the heart muscle is adequate, and determine whether medical treatment with conventional drugs will be effective. In the process we are able to prevent most patients from undergoing angiograms, angioplasty, the insertion of stents, and coronary artery bypass surgery indefinitely.

Routine Heart Examinations Result in Under Diagnosis And Under Treatment

The stethoscope and EKG will detect coronary artery disease and coronary heart disease in 10-20 % of future victims. The stress EKG will detect 10-15 % more. Not until coronary artery disease and coronary heart disease are far advanced, and often too late to treat, will these tests become abnormal. Angiograms and bypass surgery is commonly recommended at this point.

Invasive Tests (angiograms) Results In Over Diagnosis And Unnecessary Bypass Surgery

Angiograms cannot image the small arteries and collateral vessels that make up the heart's microcirculation. A coronary artery may appear to be obstructed, but the muscle it goes to often functions normally, and is in no danger because its blood supply comes from the microcirculation.

Noninvasive Testing Entails

Placing radioactive detectors, sonar devices, electronic sensors, pulse transducers, and microphones on the chest. No catheters, tubes or needles enter or "invade" the body. Unlike bypass surgery or angioplasty it is not necessary to perform angiograms first.

Noninvasive Tests Image And Permanently Record:

• localized abnormalities of motion of heart muscle due to obstructive coronary artery disease.
• flow of blood in heart muscle and chambers.
• thickness of heart's muscular walls.
• dimensions of the heart's chambers.
• structure and motion of its valves.
• obstruction or leakage of valves.
• heart murmurs: their origin, and the volume, velocity and pattern of blood flow through each valve.
• duration of each phase of the cardiac cycle (electrical activation, rise in pressure, ejection of blood, relaxation, early and late filling of the heart, and atrial contraction).
• normal and abnormal heart sounds.
• systolic and diastolic heart function.
• fraction of blood ejected each beat.

Noninvasive Tests Are Extremely Sensitive In The Early Detection Of Coronary Artery Disease And Coronary Heart Disease

Heart disease, if present, will be found with resting tests in 85-90 % of patients even in those without symptoms. Exercise tests with noninvasive studies will identify almost all of the remainder. In contrast, up to 40% of women and 10-15% of men with chest pain, in whom bypass surgery or angioplasty are being considered are found to have normal or nearly normal coronary arteries when angiograms are performed.

The Information Derived:

• allows early discovery of coronary disease, or its progression before symptoms appear, and before bypass surgery or angioplasty is recommended.
• identifies patients with low or high risk of future heart attacks.
• makes possible the early detection of complications.
• provides a more precise determination of cardiac function and disability.
• determines which drugs and optimal dosages are best used in treatment.

Once Coronary Artery Disease Or Coronary Heart Disease Is Found

then predisposing conditions that accelerate its progression can be identified, treated, and eliminated. Drugs which protect the heart and improve its blood supply and function can then be given. The same noninvasive tests used for early diagnosis may be utilized to monitor the patient's progress. These can be compared with previous tests in order to optimize treatment, and to detect and treat adverse changes even before symptoms appear.

Noninvasive Tests Avoid The Need For Angiograms That Lead To Unnecessary Bypass Surgery Or Angioplasty

Angiograms tell us about the coronary arteries and coronary artery disease, but not about the heart's function. In contrast, noninvasive tests picture the heart's anatomy, its function, and the blood flow through its muscle and its chambers. Since prognosis and survival are related more to the heart's function than to coronary artery narrowing, such data is vital in deciding if a patient can be treated with drugs, bypass surgery or angioplasty.

Bypass Surgery And Angioplasty Are Rarely Needed

Modern drug therapy combined with serial, noninvasive testing provides alternative medical therapy, and has revolutionized the treatment of coronary artery disease.

Heart Disease Can Be Benign

Modern drugs are so effective that an approaching heart attack often may be prevented entirely. Also, other late complications such as heart failure usually can be avoided. Thus, heart disease often becomes a relatively benign illness with few or no symptoms and a normal life span.