Heartfelt from page 25

duce, a light bulb went on. But the switch
had been flipped many times before'
The two-year Beaumont study involved
197 patients who were recruited as they
came into the emergency room with heart
attack symptoms. Randomly, half were
assigned to have the CT scan and the oth-
ers to undergo standard diagnostic treat-
ment.
"Our research showed coronary CT
angiography can detect if arteries are nor-
mal or diagnose mild, moderate or severe
blockages with a high degree of accuracy,
exceeding 95 percent, without invasive
cardiac catheterization;' Goldstein said.
"The holy grail of the field is to detect
these plaques (blockages)!"
Six million patients annually seek
emergency treatment for chest pain in
the United States, according to the Journal
of the American College of Cardiology,
which published Goldstein's account of the
Beaumont study in its February issue.
"At least half have inconclusive early
test results and, of these, approximately 65
percent are eventually found not to have
suffered a heart attack;' the journal stated.
A new, larger study of 750 low-risk
patients across the country will test
Beaumont's results.
"For research like this, it's early:"
Goldstein acknowledged. "The most impor-
tant part is the limitations of this study."
He says, for instance, that the CT scan is
less helpful for patients who are known to
have coronary artery disease and may not
produce clear images in obese patients.

Radiation's Effect
In an editorial that accompanied
Goldstein's article, the issue of radiation
exposure was raised.
And, the Journal's editor-in-chief, Dr.
Anthony N. DeMaria, wrote: "These data
demonstrate a potential application of
CT angiography for the rapid assessment
of chest pain in the emergency room.
However, it must be acknowledged that
the patient population was limited ... and
that the primary benefit was in detecting
abnormalities sooner and more inexpen-
sively, but not more accurately. The effect
of the earlier diagnosis upon outcome also
remains to be determined."
"The best papers say: I'm beautiful but
I've got a blemish right here Goldstein
pointed out. "I'm very confident that our
results are accurate
Indeed, Beaumont is regularly using CT
testing for its low-risk patients.
This isn't the first potential break-
through in which Goldstein has been
involved. One important contribution
derived from work demonstrating that
patients with heart attacks typically har-
bored more than one unstable region in
their arteries. Until then, a heart attack
was always thought to be a local vascular
accident, he said.
"We showed that 50 percent of patients
have at least one other unstable blockage;
that the area that announces the problem
is only the tip of the iceberg!"
Another long-standing area of inter-
est has been in patients who suffer heart

Dr. Gilbert Raff, standing, and Dr. James Goldstein view CT-delivered heart images
on a computer screen.

Recognize Heart
Attack Symptoms

C

hris Simpson, a Troy wife,
mom and grandmother, is a
ready spokeswoman for the
CT scan. At 59, she had a strong fami-
ly history — father, mother and brother
— of heart disease.
"My dad died of his fourth heart
attack and my brother had a heart
attack and bypass surgery in his early
40s," she said.
"I was aware of the kind of symp-
toms that women have and that they
can be different from men," she said.
So when, in 2005, Simpson experi-
enced several. bouts of moderate dizzi-
ness and jaw ache after exercising, she
headed to Beaumont Hospital-Royal

26

April 26 • 2007

Oak where she agreed to be part of
the study. "I wasn't even experiencing
any pain at the time," she said.
She drew the CT scan, which quickly
showed a lesion as well as other
blocked arteries. She had one stent
put in at the time, then over a few
more weeks, three more.
"I was happy to participate,"
Simpson said. "One of the best advan-
tages is that it is done very quickly
and quick response to heart attacks
controls damage."
Simpson, a writer/designer for 0/E
Learning in Troy, is on a regimen of
cholesterol and .blood pressure-reduc-
ing drugs; she has had no recurrence
of symptoms. "I have the feeling that I
dodged the bullet," she said.
Coronary disease is America's No.1

killer, according to the American Heart
Association. Recognizing symptoms of
a heart attack and getting to the hos-
pital immediately could be the differ-
ence between life and death, the heart
association says.
Some heart attacks are sudden and
intense — the "movie heart attack"
where no one doubts what's hap-
pening. But most heart attacks start
slowly, with mild pain or discomfort.
Often, people affected aren't sure
what's wrong and wait too long before
getting help.
The American Heart Association
warns you to call 911 if you have any of
the following symptoms:
•Chest discomfort. Most heart
attacks involve discomfort in the center
of the chest that lasts more than a few

minutes, or that goes away and comes
back. It can feel like uncomfortable
pressure, squeezing, fullness or pain.
•Discomfort in other areas of the
upper body. Symptoms can include
pain or discomfort in one or both arms,
the back, neck, jaw or stomach.
•Shortness of breath, with or with-
out chest discomfort.
•Other signs may include breaking
out in a cold sweat, nausea or light-
headedness.
•Women should be alert to the fact
that although chest pain or discom-
fort is a sign, they are more likely to
experience some of the other common
symptoms, particularly shortness of
breath, nausea/vomiting and back or
jaw pain.

- Judith Doner Berne