Diagnosing heart disease

Despite a patient's normal heart scans, an attentive UCI Health cardiologist pursued more tests that headed off potential trouble

April 11, 2014

Lois Wareham knew something wasn’t quite right. She was frequently tired and often felt anxious, as if a panic attack loomed.

Initially, the 71-year-old City of Orange resident attributed this to her multiple sclerosis. But her fatigue continued so she decided to get a coronary calcium scan. The elevated calcium levels prompted her to seek out UCI Health cardiologist Dr. Shaista Malik to help figure out her next steps.

Malik ordered a stress test to evaluate whether any significant blockages existed within the arteries of Wareham's heart, since a calcium score by itself doesn’t indicate the extent of blockage.

“An elevated coronary artery calcium score is caused by plaque in the arteries of the heart and indicates cardiovascular disease,” says Malik, an associate professor of cardiology at the UC Irvine School of Medicine. “A higher score means a greater amount of coronary artery plaque. This elevated number really concerned me.” 

Wareham’s stress test results showed normal blood flow to the heart muscle. Wareham was put on statins to lower her cholesterol and on medications to control her blood pressure; however, she couldn't tolerate the medications and continued to feel fatigued.

Wareham's continuing symptoms and risk factors were a lingering concern so Malik suggested an angiogram. Wareham was reluctant to undergo an invasive test initially, given the normal stress test result, so a less invasive cardiac CT angiogram was done. It showed significant disease in the arteries of her heart.

Subsequently, heart catheterization and angioplasty showed triple vessel disease, meaning Wareham had prominent blockages in her coronary arteries. A drug-eluting stent was placed to open an artery that had an 80 percent blockage. This type of stent is coated with medication that is slowly released to help prevent the growth of scar tissue in the artery lining. It also helps the artery wall remain smooth and open to ensure good blood flow. 

Although there was blockage in the other two arteries, additional testing during the catheterization showed that these arteries did not need stents.

In addition to the one stent, Wareham was also put on aspirin and Plavix, a blood thinner, which she will need to take for a year to ensure that the stent stays open.

After her procedures, Wareham was referred to the UCI Health Preventive Cardiology Program. Over the course of six months, she quit smoking and made many lifestyle changes. Through a heart-healthy diet and an exercise regimen, Wareham lost a significant amount of weight. Her blood pressure and cholesterol levels continue to improve.

“The great lesson with Lois is that she was her own health advocate and sought additional answers when she wasn’t satisfied with her initial screenings and results of her stress test,” says Malik. “Physicians really need to listen to their patients because women don’t have the same signs for heart disease as men. One negative test does not completely rule out cardiac disease.”

Malik says it's also important to note that exercise and dietary changes at any age will benefit each of us, that it’s never too late to start a heart healthy lifestyle. 

Malik and other UCI Health experts encourage patients to take a proactive role in their medical care and be sure to ask their primary care providers about the latest trends in research for health-related topics that affect them.

For more information on the Preventive Cardiology Program, call 714-456-6699.

— Susan Thomas, UCI Health Marketing & Communications