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Heart Disease is the leading cause of mortality in both men and women. Unfortunately, many patients go undiagnosed for years due to atypical symptoms or failure to present to their physicians, even when experiencing classic symptoms of CAD or PVD. Women in particular have quite atypical symptoms of coronary disease including syncope, dizziness, weakness, shortness of breath, jaw or tooth pain, etc.

Peripheral arterial disease is even more difficult to identify, as most patients don't have classic claudication. Moreover, patients don't often have TIA's as a warning sign of carotid disease. Typically, a stroke or MI is the presenting sign of significant vascular disease. These diseases carry substantial morbidity (and mortality) and can alter a patient's quality of life within seconds.

Newer diagnostic modalities allow for earlier detection of vascular disease. New cholesterol panels (VAP test, hsCRP, Lp(a), for example) provide a much more detailed assessment of coronary risk. Carotid intima-media thickness (IMT) is a novel way of detecting early cholesterol plaque in the carotid arterial wall. Coronary calcium scoring with CT has been popular of late in detecting plaque burden in the coronary arteries, although one must recognize that typically soft, uncalcified plaque leads to acute MIs and sudden death more so than hard, calcified plaque.

The newest diagnostic tool of non-invasive coronary artery CT angiography allows for accurate assessment of actual coronary anatomy. A normal coronary CT angiogram has the highest negative predictive value of ANY cardiac diagnostic test (higher than PET), is noninvasive, and can be performed within 6-8 seconds.

There are many complex factors at play when evaluating a patient with potential or known CAD. There are more and more (expensive) tests available for screening and diagnosis every year. A cardiologist with expertise in cardiac imaging can easily help determine which is the most appropriate test for a given situation or constellation of symptoms.

Dr. Ludington is board certified in nuclear cardiology and has Level III (highest) training in cardiac MRI as well as Level II training in cardiac CT angiography. She has directed the advanced imaging program at the prestigious Scripps Clinic for 5 years and can help determine which test is most appropriate for your patient.

Dr. Ludington was featured on the front page of the Union Tribune Sunday Edition on October 1st, 2006. Click here to see the article.

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