Coronary Artery Disease (CAD) Testing
Dr. Piyush Sovani explains coronary artery disease (CAD), including symptoms and who is at risk, preventative testing and understanding what the test results mean.
Featured Speaker:
Learn more about Dr. Piyush Sovani, MD
Piyush Sovani, MD
Dr. Piyush Sovani is board certified in echocardiography, nuclear medicine, vascular imaging, and internal medicine. He completed his undergraduate degree in neuroscience at Johns Hopkins University in Baltimore, Maryland. He then completed a graduate degree in physiology at Georgetown University in Washington, DC. Dr. Sovani earned his Doctor of Medicine from Marshall University Joan C. Edwards School of Medicine in Huntington, West Virginia. He continued his medical education by completing an internal medicine residency at Medstar Georgetown University Hospital in Washington, DC, followed by a cardiology fellowship at Northwell Health North Shore and Long Island Jewish Hospitals in Manhasset, New York. Dr. Sovani is a member of the American College of Cardiology and the American College of Physicians. He speaks Hindi and Marathi and is associated with St. Joseph’s Hospital.Learn more about Dr. Piyush Sovani, MD
Transcription:
Coronary Artery Disease (CAD) Testing
Intro: This is BayCare HealthChat, another podcast from BayCare Health System.
Caitlin Whyte: Welcome to BayCare HealthChat. I'm Caitlyn Whyte. And in this episode, we will be discussing coronary artery disease or CAD, touching on preventative testing, symptoms, those at high risk and understanding what the test results mean.
Joining us is Dr. Piyush Sovani who specializes in cardiovascular diseases and internal medicine. So doctor, starting off here, just what is coronary artery disease?
Piyush Sovani, MD: So coronary artery disease is the laying down of plaque in people's heart arteries. We all have cholesterol that is in our blood vessels and, eventually, that cholesterol deposits on the vessel and forms plaque. And when that plaque is found in your heart arteries, you're considered to have coronary artery disease.
Caitlin Whyte: So how does someone know if they need to be tested for this?
Piyush Sovani, MD: Coronary artery disease, unfortunately, the beginning of it can have no symptoms. So as plaque deposits in our blood vessels, our blood vessels and our heart can compensate for that deposition and continue providing adequate blood flow to the heart. It's thought that until the plaque gets to around 70% of the width of the diameter of the vessel, when it crosses that threshold is when we start to experience symptoms, symptoms such as chest pain, shortness of breath or dizziness upon exertion. Those are few of the first symptoms that manifest with coronary artery disease.
Unfortunately, there are also atypical presentations. For example, some people can have stomach pain or back pain that can also be due to coronary artery disease. And furthermore, coronary artery disease can be asymptomatic even when the plaque buildup crosses that 70% threshold. So it's best to just talk to your primary care provider or your cardiologist about your symptoms and about your history in order to see if they recommend further testing.
Caitlin Whyte: So would I have to go seek out a cardiologist right from the start or could my primary care physician order these tests?
Piyush Sovani, MD: Not necessarily. A lot of primary care physicians are comfortable with ordering some of these tests. However, a few of these tests are a little bit more complicated or complex, I should say, and really depend on your EKG and risk factors for which is the right test for you. So it just depends on the comfortability of your primary care provider, but they are certainly able to order these tests preliminarily.
Caitlin Whyte: Well, that brings me into the next section here. We're going to talk about different kinds of testing. So, to start off, let's talk about preventative testing. What does that look like?
Piyush Sovani, MD: Okay. So preventive testing includes a CT scan of your heart. It's called a coronary artery calcium scan. We were talking a little bit about how we all have cholesterol and it deposits on your blood vessels as plaque. That plaque eventually turns into calcium and we are able to detect that calcium with coronary artery calcium scan. Now, we know that if your score is zero on that test, your ten-year risk of having heart disease is very minimal.
However, if you do have calcium, we can through thousands of individuals that we've studied, your age, we can tell you which percentile you fall under. So say you have some calcium, but you fall under the fifth percentile compared to everyone, then we know that you have some calcium, but you're still doing pretty well. Whereas if you fall in under the 95th percentile, then we know you have a lot of calcium compared to everyone your age, and we really need to work hard to stop the progression of this. So that's the main asymptomatic and preventive tool that we have to tell if you have coronary artery disease or not.
There are other tests that we can recommend if someone has symptoms concerning for coronary artery disease. One of the most basic tests is an exercise stress test, where you get on a treadmill and you're hooked up to an EKG machine and blood pressure cuff and a heart rate monitor. And we have you exert yourself because, if there's a blockage in the heart artery, it may not manifest at rest. However, when you exert yourself and since your heart is like any other muscle, when it's working hard, it needs more blood flow, that's when the blockage can come into play. So that's why we get you on a treadmill, have you exert yourself and then look at the EKG, the blood pressure and the heart rate.
Another form of this test is a nuclear stress test where if you can't get on a treadmill or there are certain EKG findings that prevent you from exercising, then we give you a medication to simulate exerciseand what that does is it opens up all your blood vessels. And so if there's a blood vessel with a blockage, that will stand out on imaging after we give you a nuclear tracer. There's also a test called a coronary CT angiogram, where we inject dye and look at a CT scan to see if there's any blockages in your heart vessels.
And then finally, there's the gold standard of all the tests called a coronary angiogram. And this is also the most invasive. This is when we start an IV in your wrist or your leg artery. And then put a catheter and take it to the heart and shoot dye to look at the blood vessels leading to the heart. This is the gold standard because we're directly looking at plaques, how big they are. However, it's also the most invasive because we are risking infection, bleeding, damage to the heart, damage to the kidneys. So the risks and benefits have to be taken into account when this test is performed.
Caitlin Whyte: And lastly, talking about high risk individuals, who is considered high risk and what kind of testing is done for them?
Piyush Sovani, MD: So high-risk individuals are people that have cardiac risk factors, such as high blood pressure, diabetes, high cholesterol levels, people that have a long history of smoking. And people that have a family history of heart disease. Those are the people that even though they are not manifesting signs or symptoms of heart disease at the time, it should be evaluated periodically to make sure that the signs don't come up.
And some of the testing that we talked about can apply to those people, namely coronary artery calcium score to see if they have any heart disease and even an echocardiogram. An echocardiogram is an ultrasound of your heart that gives us the pump function of your heart, the different chamber sizes and any valvular abnormalities. This is also a great test because it does not require any radiation, any IVs or any dyes, and it can give us a lot of information. So those are the people that should go in for an evaluation of their heart and possibly get one of these preventive testings done to catch any issues, if they were to come up in the future, to catch them early on.
Caitlin Whyte: And wrapping up here, help us understand what different test results may mean.
Piyush Sovani, MD: So different test results may mean that we can treat heart disease with medications. We can treat heart disease with surveillance or something more invasive may need to be done such as a stent or a bypass. We're finding out more and more nowadays that mild or moderate blockages can be treated effectively with medications. And it's the severe blockages that put a big part of your heart at risk that really need the stents. So what our practice is evolving and doing is that we're treating a lot of these mild and moderate blockages with medications. And if the symptoms are controlled with medications, great. However, if the symptoms progress or are not controlled with medications, then we recommend more invasive treatments such as a stent or a bypass.
Caitlin Whyte: Great. Well, doctor, is there anything else you'd like to share with us today?
Piyush Sovani, MD: I think the best thing to do is focus on prevention of this and what that means is continuing to exercise. The official recommendation is 150 minutes of aerobic activity per week. Secondly, continuing to eat healthy. Most recently, the Mediterranean diet, as well as a plant-based diet has been shown to have the most favorable cardiovascular results. Thirdly is making sure that your blood pressure is under control. Fourth is making sure that cholesterol is under control. And fifth, we've seen most reduction with heart disease when people stop smoking. So those are the five tenets of preventing heart disease that are important.
Thank you so much for joining us today, doctor. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels. This has been another episode of BayCare HealthChat. I'm Caitlyn White. Stay well.
[TJA1]Audio edit at 9:42-9:43 – it should be BayCare.org
Coronary Artery Disease (CAD) Testing
Intro: This is BayCare HealthChat, another podcast from BayCare Health System.
Caitlin Whyte: Welcome to BayCare HealthChat. I'm Caitlyn Whyte. And in this episode, we will be discussing coronary artery disease or CAD, touching on preventative testing, symptoms, those at high risk and understanding what the test results mean.
Joining us is Dr. Piyush Sovani who specializes in cardiovascular diseases and internal medicine. So doctor, starting off here, just what is coronary artery disease?
Piyush Sovani, MD: So coronary artery disease is the laying down of plaque in people's heart arteries. We all have cholesterol that is in our blood vessels and, eventually, that cholesterol deposits on the vessel and forms plaque. And when that plaque is found in your heart arteries, you're considered to have coronary artery disease.
Caitlin Whyte: So how does someone know if they need to be tested for this?
Piyush Sovani, MD: Coronary artery disease, unfortunately, the beginning of it can have no symptoms. So as plaque deposits in our blood vessels, our blood vessels and our heart can compensate for that deposition and continue providing adequate blood flow to the heart. It's thought that until the plaque gets to around 70% of the width of the diameter of the vessel, when it crosses that threshold is when we start to experience symptoms, symptoms such as chest pain, shortness of breath or dizziness upon exertion. Those are few of the first symptoms that manifest with coronary artery disease.
Unfortunately, there are also atypical presentations. For example, some people can have stomach pain or back pain that can also be due to coronary artery disease. And furthermore, coronary artery disease can be asymptomatic even when the plaque buildup crosses that 70% threshold. So it's best to just talk to your primary care provider or your cardiologist about your symptoms and about your history in order to see if they recommend further testing.
Caitlin Whyte: So would I have to go seek out a cardiologist right from the start or could my primary care physician order these tests?
Piyush Sovani, MD: Not necessarily. A lot of primary care physicians are comfortable with ordering some of these tests. However, a few of these tests are a little bit more complicated or complex, I should say, and really depend on your EKG and risk factors for which is the right test for you. So it just depends on the comfortability of your primary care provider, but they are certainly able to order these tests preliminarily.
Caitlin Whyte: Well, that brings me into the next section here. We're going to talk about different kinds of testing. So, to start off, let's talk about preventative testing. What does that look like?
Piyush Sovani, MD: Okay. So preventive testing includes a CT scan of your heart. It's called a coronary artery calcium scan. We were talking a little bit about how we all have cholesterol and it deposits on your blood vessels as plaque. That plaque eventually turns into calcium and we are able to detect that calcium with coronary artery calcium scan. Now, we know that if your score is zero on that test, your ten-year risk of having heart disease is very minimal.
However, if you do have calcium, we can through thousands of individuals that we've studied, your age, we can tell you which percentile you fall under. So say you have some calcium, but you fall under the fifth percentile compared to everyone, then we know that you have some calcium, but you're still doing pretty well. Whereas if you fall in under the 95th percentile, then we know you have a lot of calcium compared to everyone your age, and we really need to work hard to stop the progression of this. So that's the main asymptomatic and preventive tool that we have to tell if you have coronary artery disease or not.
There are other tests that we can recommend if someone has symptoms concerning for coronary artery disease. One of the most basic tests is an exercise stress test, where you get on a treadmill and you're hooked up to an EKG machine and blood pressure cuff and a heart rate monitor. And we have you exert yourself because, if there's a blockage in the heart artery, it may not manifest at rest. However, when you exert yourself and since your heart is like any other muscle, when it's working hard, it needs more blood flow, that's when the blockage can come into play. So that's why we get you on a treadmill, have you exert yourself and then look at the EKG, the blood pressure and the heart rate.
Another form of this test is a nuclear stress test where if you can't get on a treadmill or there are certain EKG findings that prevent you from exercising, then we give you a medication to simulate exerciseand what that does is it opens up all your blood vessels. And so if there's a blood vessel with a blockage, that will stand out on imaging after we give you a nuclear tracer. There's also a test called a coronary CT angiogram, where we inject dye and look at a CT scan to see if there's any blockages in your heart vessels.
And then finally, there's the gold standard of all the tests called a coronary angiogram. And this is also the most invasive. This is when we start an IV in your wrist or your leg artery. And then put a catheter and take it to the heart and shoot dye to look at the blood vessels leading to the heart. This is the gold standard because we're directly looking at plaques, how big they are. However, it's also the most invasive because we are risking infection, bleeding, damage to the heart, damage to the kidneys. So the risks and benefits have to be taken into account when this test is performed.
Caitlin Whyte: And lastly, talking about high risk individuals, who is considered high risk and what kind of testing is done for them?
Piyush Sovani, MD: So high-risk individuals are people that have cardiac risk factors, such as high blood pressure, diabetes, high cholesterol levels, people that have a long history of smoking. And people that have a family history of heart disease. Those are the people that even though they are not manifesting signs or symptoms of heart disease at the time, it should be evaluated periodically to make sure that the signs don't come up.
And some of the testing that we talked about can apply to those people, namely coronary artery calcium score to see if they have any heart disease and even an echocardiogram. An echocardiogram is an ultrasound of your heart that gives us the pump function of your heart, the different chamber sizes and any valvular abnormalities. This is also a great test because it does not require any radiation, any IVs or any dyes, and it can give us a lot of information. So those are the people that should go in for an evaluation of their heart and possibly get one of these preventive testings done to catch any issues, if they were to come up in the future, to catch them early on.
Caitlin Whyte: And wrapping up here, help us understand what different test results may mean.
Piyush Sovani, MD: So different test results may mean that we can treat heart disease with medications. We can treat heart disease with surveillance or something more invasive may need to be done such as a stent or a bypass. We're finding out more and more nowadays that mild or moderate blockages can be treated effectively with medications. And it's the severe blockages that put a big part of your heart at risk that really need the stents. So what our practice is evolving and doing is that we're treating a lot of these mild and moderate blockages with medications. And if the symptoms are controlled with medications, great. However, if the symptoms progress or are not controlled with medications, then we recommend more invasive treatments such as a stent or a bypass.
Caitlin Whyte: Great. Well, doctor, is there anything else you'd like to share with us today?
Piyush Sovani, MD: I think the best thing to do is focus on prevention of this and what that means is continuing to exercise. The official recommendation is 150 minutes of aerobic activity per week. Secondly, continuing to eat healthy. Most recently, the Mediterranean diet, as well as a plant-based diet has been shown to have the most favorable cardiovascular results. Thirdly is making sure that your blood pressure is under control. Fourth is making sure that cholesterol is under control. And fifth, we've seen most reduction with heart disease when people stop smoking. So those are the five tenets of preventing heart disease that are important.
Thank you so much for joining us today, doctor. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels. This has been another episode of BayCare HealthChat. I'm Caitlyn White. Stay well.
[TJA1]Audio edit at 9:42-9:43 – it should be BayCare.org