Chest Pain Evaluation

Chest pain may have many different causes. Not all chest pain is associated with the heart. Acid reflux, gallbladder problems, bone or muscle pain, inflammation of the sack around the heart (pericarditis), blood clots in the lung (pulmonary embolism), and dissection or penetrating ulcers of the aorta, all can present with chest discomfort. Depending on the clinical picture, a number of different imaging modalities, as well as lab tests can be used to determine the cause of chest pain.

Coronary Artery Disease Monitoring

Once the presence of coronary artery disease has been established with the benefit of heart catheterization, coronary CT angiography, or electron Bean CT we are dealing with a chronic disease. Chronic diseases, by definition, mandate chronic and permanent monitoring with specific attention to certain parameters. In the case of coronary artery disease, use of Aspirin, cholesterol lowering drugs, as well as a class of blood pressure lowering medications known as Beta-Blockers are indispensible to the long term treatment of the patients. Additionally, depending on the level of activity of each individual and the related symptoms, the extent and severity of the underlying coronary artery disease, and possible history of diabetes, periodic imaging studies may be indicated.

Congestive Heart Failure

Patients who have established disease affecting the blood vessels to the heart (coronary artery disease) are at increased risk of having a similar problem affecting the blood vessels elsewhere in the body, and vice versa. In the brain, this process predisposes the patients to the risk of stroke; in the kidneys, this can lead to kidney failure and high blood pressure; and in the legs, the end result will be pain associated with walking which improves with cessation of activity. The evaluation for presence of peripheral vascular disease is primarily symptom driven.

Peripheral Vascular Disease

Patients who have established disease affecting the blood vessels to the heart (coronary artery disease) are at increased risk of having a similar problem affecting the blood vessels elsewhere in the body, and vice versa. In the brain, this process predisposes the patients to the risk of stroke; in the kidneys, this can lead to kidney failure and high blood pressure; and in the legs, the end result will be pain associated with walking which improves with cessation of activity. The evaluation for presence of peripheral vascular disease is primarily symptom driven.

Cholesterol Disorders

Optimization of the cholesterol profile is the corner stone of treatment for patients with coronary artery disease and peripheral vascular disease. Once the presence of any plaque, anywhere in the vascular tree is demonstrated, the target for the Low Density Lipoprotein is 70 or below. Depending on the individual patient’s history and risk factors, in some instances a more aggressive lipid lowering strategy may be called for. Apo-protein-B and Lipo-protein (a) are two of the parameters that can be used to guide this determination.

Syncope Evaluation

Diagnosing the cause of syncope is often a challenging problem which may require input from a number of different specialists. Unfortunately, the cause of isolated episodes of syncope may often go unidentified, despite extensive evaluation. The basic electrocardiogram (EKG), along with echocardiogram, and exercise treadmill test in conjunction with a detailed history is often adequate in ruling out primary cardiac causes of syncope. Depending on the details of the history provided by the patient, wearing an event recorder, implantation of a loop recorder, or tilt-table testing may also be called for.

Valvular Heart Disease

The heart is a pump, and just like any mechanical pump it has a number of valves, four to be exact. The valves which are predisposed to malfunction leading to symptoms are primarily the two on the left side of the heart. The aortic valve separates the left ventricle, from the aorta, and the mitral valve separates the left atrium from the left ventricle. The leakage (regurgitation) and narrowing (stenosis) of these valves are the most commonly encountered valve related problems. Depending on the severity of the leakage, and other structural parameters related to the heart chambers, as well as the patient’s symptoms, different therapeutic options are pursued for these patients.

Hypertension

The predominant majority of cases of hypertension are primary in nature, i.e., there is no underlying cause or culprit process which brings about the elevation of the blood pressure. A very small percentage of the patients are affected by secondary hypertension, or a combination of primary and secondary processes. Embarking on an exhaustive evaluation of potential secondary causes of hypertension is not called for in every instance. Depending on the clinical presentation, however, the existence of a number of conditions may need to be ruled out in these patients.