Medical Tests & Procedures Archive


Conversation with an expert: Plavix: What you need to know

Readers often ask us about the use and safety of Plavix after angioplasty. We turned for answers to Dr. Patrick O'Gara, a member of the Heart Letter editorial board, who helped write a clinical alert about Plavix for the American Heart Association.

Almost every medical advance raises issues that demand creative problem-solving. Take artery-opening angioplasty. It uses a tiny balloon to flatten a cholesterol-filled plaque, restoring blood flow through a narrowed or blocked coronary artery without open-heart surgery. A wire-mesh stent is usually left behind to hold open the artery. However, blood clots sometimes form on a stent. This can block blood flow through the artery, causing a heart attack or sudden cardiac arrest. Taking a drug called clopidogrel (Plavix) with aspirin can fight this problem. But this combination, often called dual antiplatelet therapy, can be hard on the stomach, interacts with some drugs, and must be taken without interruption for a specified period.

On the horizon: Removing fat makes HDL ("good cholesterol") even better

High-density lipoproteins (HDL) protect the heart and arteries by removing cholesterol lodged in artery walls and riding through the bloodstream inside of low-density lipoproteins (LDL). Here's a novel way to amplify HDL's cholesterol-busting activity: Take some blood from a person. Extract the HDL. Use a process called delipidation to remove cholesterol and other fats (lipids) from the HDL. Then put the defatted HDL particles back into the bloodstream. This seems to turbocharge HDL and make it work even more aggressively against cholesterol.

In the first clinical trial of HDL delipidation in humans, the procedure was safe and effective. Treated HDL caused cholesterol-filled plaque to shrink more than did untreated HDL (Journal of the American College of Cardiology, June 15, 2010). The trial was too small and didn't last nearly long enough to see if this prevented future heart attacks or improved survival.

Ask the doctor: Do I really need surgery to fix my aortic valve?

Q. I have had a leaking aortic valve for many years. I get an echocardiogram every six months. After the latest one, my doctor told me that my heart was enlarging and asked me repeatedly whether I was getting short of breath with exercise. I told him that sure, I get tired, but it isn't like I am breathing hard while sitting still. Now he wants me to have surgery to replace the valve. Should I do this at age 68?

A. You have been getting exactly the right attention for what is called aortic regurgitation. This is the backflow of some blood into your left ventricle with each heartbeat, instead of it all going into your aorta.

Ask the doctor: What can you tell me about surgery for vertebral fractures?

Q. I have osteoporosis and a recent spine fracture. I hear there's a minor surgical procedure that can fix the fracture. Can you tell me anything about it?

A. Fractures of the bones in the spinal column (vertebrae) are common in people with osteoporosis; about 750,000 occur each year in the United States. In this type of fracture, called a compression fracture, the vertebra collapses, often causing pain, a gradual loss of height, or stooped posture. Even if the fracture doesn't cause obvious symptoms, having one fracture increases the risk of having another one. The cumulative effect of multiple fractures is chronic pain, disability, depression, and difficulty managing normal daily activities.

Radiation risk from medical imaging

Given the huge increase in the use of CT scans, concern about radiation exposure is warranted. Patients should try to keep track of their cumulative radiation exposure, and only have tests when necessary.

Clearing clogged arteries in the neck

Balloon angioplasty appears to be just as good as surgery to unblock carotid arteries.

Date of last review, March 25, 2020Opening a blocked heart artery with a balloon and then propping it open with a wire-mesh stent is more commonly used than bypass surgery for restoring blood flow to the heart. Although coronary angioplasty plus stenting isn't quite as durable as bypass surgery, it is much easier on the body, since it doesn't require opening the chest.

The situation is similar in the carotid arteries, which convey oxygen-rich blood to the brain. In that territory, carotid angioplasty plus stenting (CAS) for many people has become preferred to endarterectomy, an operation to clean out a clogged carotid artery.

Exercise stress test

The treadmill test can reveal hidden problems in the heart.

One way to judge the health of the heart and the arteries that supply it with oxygen and nutrients is to make them work harder. That's the principle behind one of the most commonly used tests in cardiology, the exercise stress test (also known as the exercise tolerance test, treadmill test, or just the stress test). It's much the same thing a mechanic does when he or she races a car's engine.

C-Reactive Protein test to screen for heart disease: Why do we need another test?

The predictive powers of a cholesterol test only go so far. If your LDL is low, your C-reactive protein may be a better sign of impending heart trouble.

The gap between knowing what's good for you and actually doing it can be huge, especially when it comes to something like getting exercise. (Never underestimate the appeal of the sedentary life.) Many of us need a warning-some might say a bit of a kick in the pants-before we'll change our ways and get with a heart-healthy program.

Cholesterol Tests

For decades, cholesterol testing has served as that warning for many. An elevated level of "bad" LDL cholesterol has been just the warning people needed to change their ways. It has played that role for several reasons. People like tests because the results seem objective. Reliable measurement of cholesterol is easy and relatively inexpensive. It makes sense biologically. LDL cholesterol, a protein-wrapped package containing fat and cholesterol, tends to slip out of the bloodstream and lodge in blood vessel walls, forming the plaque that leads to clots and heart attacks.

What tests do you recommend for detecting my risk of heart disease?

Learn not only the risk factors doctors look for, but the one area more doctors are taking to heart when detecting your risk for heart disease. Dr. Paula Johnson shares the necessity of this test and what it could mean for you.

Does hypnosis work?

Hypnosis is actually an approved treatment for the relief of pain and anxiety. Dr. Michael Miller tells more about this form of psychotherapy and what to look for should you decide to try it.

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