Sometimes it comes without warning signs. A man feels in his heart (Photo: ShutterStock)
The mortality rate from myocardial infarction in Israel is among the lowest in the world, standing at only 4% per month, but the rate of complications after the heart attack is not negligible at all. What makes the story more complicated is the fact that for some people who experience a heart attack, there were no early warning signs.
"The classic cases known are those of the cyclist or runner who suddenly falls on the street," explains Prof. Nathan Peled, Chairman of the National Council for Imaging, and a radiologist at Medica Elisha Haifa. "The cardiology world is trying to deal with the phenomenon in various ways, for example by stratifying risks among the general population. One method to do this is to calculate a patient's risk of having a cardiac event, by weighting risk factors such as age, sex, family history of ischemic heart disease, hyperlipids, hypertension, diabetes and smoking. Among these patients, an optimal balance of risk factors should be carried out, as a first step, and the clinical information should be combined with an imaging test, which demonstrates the amount of calcium accumulated on the surface of the coronary arteries in the heart, in order to assess the risk of developing a cardiac event in the next 10 years. This is a simple CT scan that does not require the use of a contrast agent and involves very low exposure to radiation. The lack of calcification on the surface of the heart arteries makes the chances of a cardiac event in the next 10 years almost nil.
On the other hand, if calcium is found on the surface of the arteries, especially at young ages, it requires further attention and treatment. Of course, the presence of sclerosis in other blood vessels in the body, such as those that supply blood to the brain and legs, further increases the risk."
Only takes a few minutes: virtual catheterization
In the past two decades, far-reaching technological developments have taken place in the field of CT detectors as well as in the field of computing. The combination of advanced technologies now makes it possible to sample the heart quickly (fractions of a second), and to demonstrate the blood vessels of the heart at very high resolution. One of the most advanced tests, which has come into use in the cardiology field in recent years, is cardiac CT scan, or in its second name - virtual catheterization.
This is a non-invasive examination, which does not require insertion of a catheter into the heart, as in regular catheterization, and it enables optimal visualization of the heart, with an emphasis on the coronary arteries, and identification of morbid atherosclerotic changes at a very early stage, even before permanent damage to the heart muscle occurs. The examination is performed using a computerized tomograph that scans the body in a detailed, precise manner and at high speed, which enables optimal demonstration of the various body parts scanned, including demonstration of various organs in 48D.
"Unlike the CT scan, which examines the amount of calcium on the coronary arteries, virtual catheterization requires injection of a contrast agent, while the heart is monitored by an ECG," explains Prof. Peled. "If I photograph the heart while moving, the resulting image will be blurry. Therefore, we sample the image and precisely in the short period of time of a few hundredths of a second, we get a motionless image, in which I can clearly see the blood vessels and their wall, where it all begins. In addition, we see what the heart looks like - the heart muscles, the coronary arteries inside and out, and in fact we get a lot of information.
This is a very simple test that does not require any special preparation. The patient lies on the bed for less than a minute, and the scanner easily identifies signs of coronary sclerosis and rates them - normal, mild, moderate and severe. At the end of the examination, it is possible to return to the daily routine, with the diagnosis performed within <> hours and in urgent cases immediately. The answers reach the patient's email, and if further clarification or treatment is needed, he will be referred to a cardiologist in the community, and will of course also be entitled to speak with the cardiologist who conducted the examination."
A very simple test that does not require any special preparation (photo: courtesy of the subjects)
Who should have a cardiac CT?
"Most of the patients are referred by their family doctor or a cardiologist at the HMO, suffering from angina that is unclear whether it stems from a cardiac source," says Prof. Peled. "In these cases, the test is included in the health basket. If you decide to perform it on your own, without a doctor's referral, its cost will be NIS 2,600, and it is necessary to perform a creatinine blood test before that to check kidney function."
According to Prof. Peled, men come for the examination more than women and at an earlier stage. "The problem with women is that the symptoms they describe are less characteristic of heart disease, which causes them to come for a check-up later, thereby increasing their risk of having a cardiac event, because there are no clear precursors."
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