Plaque buildup in the heart’s arteries is fairly common, especially as we age. When plaque buildup causes an abrupt blockage of blood flow, known as acute coronary syndrome, a life-threatening heart issue like a heart attack may be present.
Emergency symptoms include unexplained chest pain or shortness of breath at rest, sometimes associated with nausea, vomiting, sweating, and feeling of impending doom, rapid heartbeat and lightheadedness. These symptoms should be checked immediately and warrant a call to 9-1-1.
For others, this buildup of fatty deposits in the heart may not cause any symptoms or cause non-urgent symptoms, known as stable coronary artery disease. For non-emergency symptoms, your doctor may recommend you undergo tests to check for and assess blockages in your heart’s arteries — like stress testing.
“Any symptom above the belly button that you cannot explain could be the heart unless otherwise proven,” said Srini Potluri, MD, medical director of the cardiac catheterization lab at Baylor Scott & White The Heart Hospital – Plano.
Depending on your age and other risk factors, noninvasive tests may be used first to assess your symptoms, such as a stress test to evaluate how well the heart functions when working at its hardest. There are different types of stress tests based on your individual factors.
“If the stress test is abnormal, it suggests that there could be a blockage,” Dr. Potluri said. “After that, we would typically proceed with an angiogram.”
An angiogram is a test performed in the cardiac catheterization lab that uses a catheter inserted in a small incision in the wrist or the groin up into the heart to eject contrast (or dye) to look for blockages. If a blockage falls into the borderline category during the angiogram, interventional cardiologists have additional tests to help further evaluate it.
“To assess the functional significance of a borderline blockage, we would do an FFR, which is a fractional flow reserve,” Dr. Potluri said. “We give the patient a medication to simulate exercise, and we assess the pressure before and after the blockage.”
In addition to FFR, doctors may also use intravascular ultrasound (IVUS), or less frequently, optical coherence tomography (OCT), which both provide images of the inside of the heart’s arteries.
Tests to assess coronary blockages help physicians determine if the blockage is the real cause of your symptoms. In some cases, symptoms could be from something else not related to the heart, like a chest injury or acid reflux. If someone has a borderline blockage, assessment also helps to decide what type of further treatment is needed, such as medication or a stent.
“We don’t want to treat a blockage because we see it,” Dr. Potluri said. “We want to treat a blockage only if it is functionally significant.”
Treatment depends on whether you have urgent symptoms, as in acute coronary syndrome, or non-urgent symptoms, as in stable coronary artery disease. Treatment will be different in those experiencing symptoms that signal an emergency.
“Acute coronary syndrome is more dangerous and has a different prognosis than stable coronary artery disease,” Dr. Potluri said.
In those with stable coronary artery disease, where no emergency intervention is needed, treatment for blocked arteries is often determined by the percentage of the artery blocked and symptoms despite medical treatment.
Typically, blockages of 70 percent or more are treated with a stent to restore blood flow. Blockages of less than 50 percent may only need medication as treatment. Treatment for those that fall in the middle or borderline category depends on the results of the additional tests performed in the cath lab, like FFR.
Learn more about how we diagnosis and treat heart conditions in the cardiac catheterization lab at Baylor Scott & White The Heart Hospital – Plano.
Physicians are members of the medical staff at one of Baylor Health Care System's subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor Scott & White The Heart Hospital – Plano or Baylor Health Care System.