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First, I am so excited for all of us to be wrapping up this class and
composing our last discussion board post.I have enjoyed learning with
everyone in this class and appreciate the perspectives that each person
has brought to enhance the subject matter each week.I have read
almost every post, even if I did not comment on them, and am grateful for
the added input each week.
On to the post- coronary artery disease, or coronary heart disease, or
ischemic heart disease, or CAD- whatever you choose to call the
condition, is the most common type of heart disease in the United States.
(Coronary artery,2021) For many, the first sign they have the condition is
a heart attack. Other symptoms include chest pain, weakness, light-
headedness, nausea, cold sweats, pain in the arm or shoulder, and
shortness of breath. In addition, there are risk factors such as being
overweight, being physically inactive, unhealthy eating habits, smoking,
as well as having family history of heart disease at age 50 or younger.If
you have symptoms or are high risk, your doctor can order one of several
tests to diagnose CAD.These tests include blood work, an ECG or EKG,
an echocardiogram, an exercise stress test, a chest x-ray, a cardiac
catheterization, a coronary angiogram, (a type of x-ray) a coronary artery
calcium CT scan, a carotid artery ultrasound, an MRI, and a positron
emission tomography (PET) scan. As technology improved, the choices
for tests that a healthcare provider could select from that could be
ordered to help with diagnosing coronary artery disease increased. These
tests vary in price and efficacy, but each can be used to make a
diagnosis.
In comparing these tests, each of them offers a different way to
examine a person’s heart, thus allowing a diagnosis to be made. Each of
these tests is effective andthe likelihood that one would result in a better
diagnosis in the case of CAD is minimal, as all tests can be used to
diagnose the condition.The severity of the condition can be seen
differently, however, depending on which test is ordered. With coronary
artery disease, diagnosing a patient in the first place is the most
important factor for finding the best course to take for treatment.
Understanding the severity can only enhance the treatment course
because the provider will better understand the severity of the patient’s
condition. The coronary angiography, or the cardiac catheterization is the
“gold standard” for testing for coronary artery disease. It is a minimally
invasive but highly effective test. (Coronary artery,n.d.)In addition to
blood work, an EKG or ECG is usually the first test ordered as it is the
simplest to use to look for signs of CAD. When considering and
comparing a CT to and MRI to a PET test, a CT scan is more widely used
than an MRI because they are less expensive.MRIs produce a superior
image with more detail seen.An echocardiogram shows smaller atrial
and ventricular dimensions and volumes and larger wall thicknesses and
mass compared to a cardiac MRI. A PET scan detects cellular changes
earlier than CTs and MRIs.Performing a PET-CT or PET-MRI
combination test produces 3D images to allow for the most accurate
diagnosis. A PET-MRI costs an average of 50% more than the PET-CT,
so this makes more sense with the differences being negligible. (PET
scan,n.d.)
The likelihood of a different procedure resulting in a better diagnosis
does happen, however. For example, in cases such as leg pain where an
x-ray shows no fracture, but the patient still has pain- A doctor can order
an CT to further investigate and be able to come to a diagnosis with the
second test as the first was inconclusive. Separately an x-ray is an
effective test, and a CT is an effective test. In this example, however, one
is more effective to make a diagnosis. If a doctor ordered an CT first,
however, many insurance companies would deny it, which could prolong
the diagnosis, unfortunately and prolong the treatment.Using this
example, if a patient with leg pain and a negative x-ray then has an CT
done, which indicates a cancerous mass, this time between symptoms
and diagnosis and treatment could be devastating.
As I mentioned, insurance companies are particular with authorizing
tests and have specific protocol that ordering providers must follow to get
some tests approved. For example, many insurance companies will not
approve an MRI or a CT for a patient until they have had 6 weeks of
conservative therapy. I understand that in some cases, tests are being
ordered unnecessarily and ultimately this is just to keep costs down, but if
an MRI or CT is really the most effective test to get to a diagnosis, it is
hard to think that treatment/cures are being delayed because of
insurance protocols.
References:
Centers for Disease Control and Prevention. (2021, July 19).Coronary artery
disease. Centers for Disease Control and Prevention. Retrieved May 25,
2022, fromhttps://www.cdc.gov/heartdisease/coronary_ad.htm
Coronary artery disease diagnosis. ucsfhealth.org. (n.d.). Retrieved May 25,
2022, fromhttps://www.ucsfhealth.org/conditions/coronary-artery-disease/
diagnosis
PET scan: Tests, types, procedure. Cleveland Clinic. (n.d.). Retrieved May 25,
2022, fromhttps://my.clevelandclinic.org/health/diagnostics/10123-pet-
scan
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