conflicting information about ways to diagnose CAD

Published

The Wall Street Journal is running an article about use of CTs to diagnosis CAD. It says reseach shows that docs CAN NOT uses CTs to replace heart caths to diagnose blockages. I found it interesting and read it out loud to my husband. It just so happened he was reading the local newspaper which contained an article that said exactly the opposite. It said CTs COULD replace heart caths. :uhoh3: I was just flummoxed by this because the two articles were it total juxtaposition to each other. I got the impression that the authors were looking at the SAME DATA!!!:icon_roll I wonder what cardiac nurses that are out there in the field are seeing and experiencing and I thought I would drop in and ask. By the way, I did quite a lot of cardiac nursing in my younger days and back then the heart cath was the gold standard. For some reason back then we used to call them Cinnies, short for cineography I think. I remember the heart caths used to be recorded two different ways and the docs used to look at both. One gave them preliminary info very quickly and the other had to be read later due to need to develope the film. I always found it very interesting and still have an interest in the field.

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Specializes in Cardiac Telemetry/PCU, SNF.

It is a big debate in cardiology. While cardiac CT, and MRI for that matter, can be helpful in diagnosing CAD it's not 100% either. The imaging guys are enamored with their pictures and believe they can see adequately the blockages that exist, just like in a heart cath. But, if they're found to have hemodynamically significant lesions they still have to go to the lab to get stented and/or ballooned.

One problem that exists with CT is the inability to determine if the lesion is hemodynamically relevant. Not all lesions are, which means they don't necessarily need to have an intervention done. The other area where CT is less-then-stellar is in diffuse soft lesions, non-calcified lesions, like soft plaques. The resolution is still not quite there.

I think it may have uses as a screening tool, but with the rad exposure during a chest CT, and cumulative exposure over time with multiple scans, it may not work out well in the wash. It looks like caths will be the standards for some time, but diagnostic imaging will be another tool they can use.

Our cardiologists are not using them, especially since our scanner is not fast enough (yet...), but it may happen.

Just my 2 bits...

Tom

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Specializes in CTICU.

I would encourage you to check the literature yourself - neither the local paper nor the wall street journal are peer-reviewed scientific journals. Go check out the source and see what you think.

Goes to show why RNs should learn research - being able to read and interpret results for family and patients is important (just a general observation, not directing that comment at any poster here).

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

http://circ.ahajournals.org/cgi/reprint/115/3/402

Here is the AHA Clinical Expert Census report from 2007. Scroll down to page 20 to get to the meat of the findings. I'm assuming there has been a new one for 2008, but it's not online yet.

When in doubt regarding cardiac practices, check with the AHA. They set the guidelines & standards for MDs & Nurses. ;)

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Specializes in Cardiac Telemetry/PCU, SNF.

Logged into Medpage today and this was on the front page:

http://www.medpagetoday.com/Radiology/DiagnosticRadiology/11927

Enjoy!

Tom

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Specializes in Cardiothoracic Transplant Telemetry.

While CT's are not used very much- after all cardiologists do get paid for doing a cath- and the radiologist gets paid to read the CT, I have seen them used a few times prior to EP studies for ablations. EP studies and ablations are understandably higher risk in those who have CAD, so often times the doc with do a heart cath one day and the EP study the next. In certain situations I have seen the doc write for the CT scans for those people who are in that grey zone age wise for CAD. In their 40-55's, with no symptoms and no pre-existing history- the doc may try for the CT scan to check for CAD when they feel that the actual chances of hemodynamically significant disease are low.

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