When imaging tests reveal unexpected findings

Thanks to advances in medical imaging, cardiologists can now visualize the heart in more detail than ever before. The information can help determine if you need medications or a procedure to reduce your risk of a heart attack or stroke. Sometimes high-tech heart scans enable people to avoid more invasive procedures (see “Heart scanning techniques”).

But the use of more advanced cardiac imaging means doctors are also seeing more potentially worrisome abnormalities both within and near the heart. “Sometimes a scan detects an unexpected finding that’s unrelated to the original reason for the test,” says cardiologist Dr. Jason H. Wasfy, director of cardiology outcomes research at Harvard-affiliated Massachusetts General Hospital and associate professor at Harvard Medical School.

Heart scanning techniquesIn a matter of minutes, cardiac CT angiography (CCTA) can capture a detailed, three-dimensional image of the blood vessels and other structures of the heart. Although this test requires an arm injection of contrast dye to “light up” the blood vessels, it’s far less invasive than traditional coronary angiography, which delivers contrast dye to the heart through a thin tube (catheter) that’s snaked through a blood vessel in the upper leg or wrist. For people who are unlikely to have narrowed arteries, CCTA can rule out that problem without resorting to invasive angiography.Here are some other methods for heart imaging:Coronary artery calcium scanning uses a special CT scanner that detects and measures the amount of calcium in the walls of the heart’s arteries. It involves small amounts of radiation but no contrast dye.Cardiac MRI uses magnets, radio waves, and a computer to create images of the heart and nearby blood vessels. It may require a contrast injection but involves no radiation exposure.Find stability with a charitable gift annuityWhen you establish a charitable gift annuity to benefit HMS, your gift will provide you and/or a loved one with a fixed income for life while supporting our mission to improve health and well-being for all.
Echocardiography uses sound waves to create moving pictures that show the size and shape of the heart as well as the function of the heart’s chambers and valves. It typically involves no dye and no radiation.

Incidentalomas: Troublesome or helpful?

Known as an “incidentaloma,” these findings might be a nodule or tumor (abnormal growths that may be benign or malignant) or more subtle but unusual changes in the heart, lungs, or other nearby areas of the body.

When doctors image the heart, they often see things in the lungs. Detecting a suspicious lung growth often leads to additional imaging tests and possibly biopsies. For patients, this often translates to considerable inconvenience, stress, expense, and risks (such as from radiation exposure and contrast dye that can harm the kidneys). More often than not, the suspicious growth turns out to be harmless. But in rare cases, it ends up being an early cancer, says Dr. Wasfy.

An echocardiogram may also reveal unanticipated findings. For example, using this test to assess heart function in someone with shortness of breath may show subtle changes in one of the heart’s valves. It might be an infection or a less-concerning buildup of calcium caused by normal aging. For these and other incidentalomas, it’s often tricky to know whether more tests are warranted — or a waste of time. Clear communication with your doctor can help, however.

Two things you can do

First, ask your physician to explain the rationale for any imaging tests he or she recommends. Be sure you understand how the results may change your treatment, which may involve stopping or starting medications or undergoing a procedure. Sometimes, doctors order tests without confirming that the patient would agree to the potential intervention, says Dr. Wasfy. “For example, it doesn’t make sense to look for a narrowing of the coronary arteries if a person doesn’t want to get a stent,” he says. Stents — tiny mesh tubes used to prop open narrowed arteries — can be lifesaving if you’re having a heart attack. But if you are not, growing evidence suggests that medications (such as those to lower cholesterol and blood pressure) are just as effective as stents in preventing heart attacks and premature death from cardiovascular disease.

Second, if you’re found to have an incidentaloma on an imaging test, consider getting a second opinion from a cardiologist or radiologist with extensive experience interpreting scans of the organ or area in question. “Getting a specialist’s opinion can give you more confidence that a concerning finding is treated appropriately,” Dr. Wasfy says.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

1 Peter 5:7 Cast all your anxiety on him because he cares for you.

Isaiah 12:2 Surely God is my salvation; I will trust and not be afraid. The Lord, the Lord, is my strength and my song; he has become my salvation.

2 Timothy 1:7 For God did not give us a spirit of timidity, but a spirit of power, of love and of self-discipline.

Psalm 138:3 When I called, you answered me; you made me bold and stouthearted.

Psalm 16:8 I have set the Lord always before me. Because he is at my right hand, I will not be shaken.

Psalm 62:1-2 My soul finds rest in God alone; my salvation comes from him. He alone is my rock and my salvation; he is my fortress, I will never be shaken.

Psalm 112: 1, 7-8 Praise the Lord! Happy are those who fear the Lord. They are not afraid of evil tidings; their hearts are firm, secure in the Lord. Their hearts are steady, they will not be afraid.

Psalm 91:1-2 You who live in the shelter of the Most High, who abide in the shadow of the Almighty, will say to the Lord, “My refuge and my fortress; my God in whom I trust.”

Psalm 112: 1, 7-8 Praise the Lord! Happy are those who fear the Lord. They are not afraid of evil tidings; their hearts are firm, secure in the Lord. Their hearts are steady, they will not be afraid.

2 Corinthians 12:9 My grace is sufficient for you, for my power is made perfect in weakness.

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