MEN'S HEALTH MATTERS:Tests for chest pain vary according to symptoms, writes THOMAS LYNCH
Q I am 58 years old and had chest pains a few weeks ago. I went to the hospital, had a few tests, and was then told that it was not related to a heart attack.
The doctors want to have my coronary arteries checked and have recommended that I have a CT of my heart.
A friend of mine had a similar complaint recently but he was admitted to hospital and had a tube inserted into his groin to get further information about the heart. Why the difference?
A Your doctors have recommended a “Coronary CTA (CT angiogram) to determine whether the arteries supplying your heart are narrowed or not. For this test you are usually in hospital for only a couple of hours.
You may be given some medication to slow your heart down slightly (which you probably won’t notice). This helps to improve the quality of the scan. At the start of the scan you may also have some other medication delivered via an aerosol into your mouth, which may allow the arteries to dilate (open wider). These medications may improve the visualisation of the arteries.
Following this, a dye is injected into a vein in your arm and, as this circulates around your body, pictures of the heart and coronary vessels are taken. Your doctors have recommended this test (presumably) because they think that it is unlikely that you have significant narrowing of the arteries.
If, however, you were admitted to hospital with chest pain and your electrocardiograph (ECG) or certain blood tests were abnormal then this may indicate narrowed coronary arteries or some damage to the heart muscle.
In this situation it is likely that you would have a catheter angiogram which is a procedure whereby dye is injected into the coronary arteries via a tube inserted into an artery in the groin or arm.
The advantage of this test is that if a narrowed artery is identified it can immediately be treated by placement of a stent which opens the artery up. However, catheter angiography is more invasive and has more side effects than CT and so is avoided in cases where it is likely that the test will be normal and no stent placement will be required.
If your doctors do find a significant narrowing on a CT scan then you will probably need to undergo catheter angiography at a later stage along with possible placement of a stent.
Q I am 43 years old and have bad scarring on my cheeks due to the fact that I had acne when I was a teenager. I read recently about having laser treatment and would like to know more about it.
A Acne scarring affects 30 per cent of people who have had moderate or severe acne. Acne scarring can be divided into early and late scarring.
The type you describe, late scars, never completely disappear. However, it can be improved with some techniques. There are different types of scar that people get with acne, and there are treatments for each type of scar. Most people have a mixture of scars and so need a mixture of treatments.
Laser resurfacing, where the top layers of the skin are vaporised, can be helpful. A similar technique, though less high-tech, is dermabrasion. Both of these work by smoothing out irregularities in the skin’s surface, and it is like sanding a rough piece of wood.
One new type of resurfacing laser avoids that “raw skin” look by breaking the laser beam up into many smaller beams, similar to the way in which a camera breaks up a picture into pixels. Other types of scar can be helped by surgery such as cutting out larger scars or grafting very small (ice pick) scars.
If you are going to have treatment for your acne scarring, it is important that you have realistic expectations of what can be done. Most studies show that if there is an improvement, it is never very marked and no treatment is ever going to give you back a perfect complexion.
The best treatment for acne scarring is to try to prevent it by seeking treatment for acne early, with a doctor or dermatologist, when you’re a teenager or young adult before the scarring occurs.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin, with a contribution from Dr Jim Meaney, consultant radiologist, St James’s Hospital, Dublin, and Dr Patrick Ormond, consultant dermatologist and dermatological surgeon, St James’s Hospital, Dublin