New Scans May Speed Chest Pain Diagnosis

Dr. James Goldstein stands next to the advance CT scanner at William Beaumont Hospital in Royal Oak, Mich., Friday, Feb. 23, 2007. Dr. Goldstein is the main researcher into ways to diagnose more rapidly whether people who come to the ER with chest pain really are having a heart attack. (AP Photo/Carlos Osorio) (Carlos Osorio - AP)

WASHINGTON -- Millions of people with chest pain enter emergency room limbo, spending up to 24 hours waiting for tests to tell if a heart attack really is brewing or if it's something less dire. A computerized heart scan may start easing the wait, giving doctors a faster picture of clogged arteries to help determine who can go home _ within just four hours _ and who needs more care. If these souped-up CT scans pan out _ and major studies of several thousand chest-pain sufferers are to begin soon _ they may do more than send the worried well home faster.

"To be able to show the patient what's going on in their arteries is very powerful," says Dr. James Goldstein of William Beaumont Hospital in Royal Oak, Mich.

He's finding that the 3-D pictures of gunk-filled arteries can motivate patients to change their heart-risky behaviors better than lecturing them about high blood pressure or cholesterol.

On the other side, when arteries look clean, "you can say the chance that this patient would have any cardiac event in the next five years will be very, very low," adds Dr. Udo Hoffmann of Massachusetts General Hospital. "If they come back a week later with chest pain, you know it's not the heart."

Sudden chest pain sends about 6 million people to U.S. emergency rooms every year. It's the most common symptom of a heart attack, but a maddening symptom, too _ because half the time it signals something other than heart disease, and telling the difference can be tough.

The dilemma starts with describing the pain. The classic "elephant on my chest" sensation isn't what everyone experiences. Some feel not pain but a tightening of the chest. Others feel pain in the arm, neck or jaw. Some people say it felt like they had a toothache before their heart attack; others felt nausea.

"Trying to sort out whether there's a life-threatening heart problem based on symptoms alone is difficult," explains Goldstein. "Sometimes it seems obvious, and you're wrong. Sometimes the symptoms are unimpressive, and you're wrong. The implications of missing the diagnosis are disastrous."

An electrocardiogram, or EKG, sometimes catches a heart attack in progress, or an artery so unstable that one's imminent.

But at least half the time, early tests are inconclusive and patients are admitted to the hospital for repeat EKGs, blood tests and other checks that can last 24 hours _ and eventually rule out a heart attack two-thirds of the time. Patient anxiety aside, the tab for all that testing surpasses $10 billion annually.

Worse are those whose heart attacks are missed, between 2 percent and 8 percent of patients who are sent home too soon.

Cardiac catheterization _ threading a probe up into the heart to view the inside of arteries _ or stressing the heart with exercise can provide a faster answer, but both are risky so doctors until now have stuck with the wait-and-see approach.

Enter CT angiography. Doctors inject patients with a dye to illuminate artery walls. Then newer machines called 64-slice CT scanners use computerized X-rays to measure both rock-like calcium and soft fatty blockages inside arteries. Within 30 minutes, the 3-D images can show if arteries are narrowed, and how much.