eMedicine Specialties > Cardiology > Atherosclerosis and Risk Factors

Atherosclerosis: Differential Diagnoses & Workup

Author: F Brian Boudi, MD, Clinical Assistant Professor, Department of Medicine, Fellow, Sarver Heart Center, University of Arizona College of Medicine; Adjunct Assistant Professor of Medicine, Mid-Western University; Consulting Staff, Director of Ambulatory Medicine Clinical Rotation, Carl T Hayden Veterans Affairs Medical Center
Coauthor(s): Chowdhury H Ahsan, MD, MRCP, PhD, FRSCAI, Clinical Professor of Medicine, Director of Cardiac Catheterization and Intervention, Director of Cardiovascular Research, Division of Cardiology, University of California Irvine, University Medical Center
Contributor Information and Disclosures

Updated: Aug 4, 2009

Workup

Laboratory Studies

  • Lipid profile: Elevated LDL cholesterol is a risk factor for atherosclerotic vascular disease. High triglycerides are associated with low high-density lipoprotein (HDL) cholesterol and are a probable risk factor for vascular disease. The National Cholesterol Education Program (NCEP) has issued guidelines for the diagnosis and optimal treatment of hyperlipidemia.
  • Blood glucose and hemoglobin A1c: Routine measurement of blood glucose and hemoglobulin A1c is appropriate in patients with diabetes mellitus. Measuring any number of parameters that may reflect inflammation, coagulation, fibrinolytic status, and platelet aggregability is possible. These measurements may prove to be valuable, but, at this time, how these measurements affect clinical decision-making is unclear, and including them in routine clinical practice is premature.

Imaging Studies

  • Ultrasonography aids in evaluating brachial artery reactivity and carotid artery intima-media thickness, which are measures of vessel wall function and anatomy, respectively. These evaluations remain research techniques at this time but hold promise as reliable noninvasive, and therefore repeatable, measures of disease and surrogate end-points for the evaluation of therapeutic interventions.
    • Brachial artery reactivity: The loss of endothelium-dependent vasodilation is a feature of even the early stages of atherosclerosis. The availability of high-resolution ultrasonographic systems makes the visualization and measurement of small peripheral conduit vessels, such as the human brachial artery, possible. Flow-mediated dilation of the brachial artery has been pioneered as a means of evaluating the health and integrity of the endothelium. The healthy endothelium dilates in response to an increase in blood flow, whereas vessels affected by atherosclerosis do not dilate and may paradoxically constrict.
    • Carotid artery intima-media thickness: B-mode ultrasonography of the common and internal carotid arteries is a noninvasive measure of arterial wall anatomy that may be performed repeatedly and reliably in asymptomatic individuals. The combined thickness of the intima and media of the carotid artery is associated with the prevalence of cardiovascular risk factors and disease and an increased risk of myocardial infarction and stroke. This association is at least as strong as the associations observed with traditional risk factors.

Other Tests

Coronary Angiography 
Coronary angiography, was the first available vivo assessment of the coronary arteries consisting of injection of an iodinated contrast agent through a catheter placed at the ostium of the coronaries. The contrast agent is then visualized through x-ray fluoroscopic examination of the heart. One of the limitations of coronary angiography is that only the vessel space occupied by blood is visualized. The actual extent of atherosclerotic plaque volume in the wall cannot be assessed with this technique.

Intravascular ultrasound (IVUS)
Intravascular ultrasound (IVUS) has long been considered the “gold standard” for the study of the anatomy of the vessel wall and is a catheter-based examination that provides images of the thickness and the acoustic density of the vessel wall. It can depict the presence of atherosclerotic plaques not visible with contrast coronary angiography and may reveal signs of recent disruption.

Computed Tomography 
Multidetector computed tomography (MDCT) technology can allow for excellent visualization of the coronary arteries but relatively high radiation dose is one of the limitations of this approach. However, newer generations of CT scanners may be able to reduce the required radiation exposure to make this technology more promising for screening asymptomatic patients.

Magnetic Resonance Imaging  
MRI can be used to noninvasively gain information about blood vessel wall structure and characterize plaque composition.

Scintigraphic Techniques  
Nuclear perfusion imaging is performed with the use of single-photon emission computed tomography (SPECT) or positron emission tomography (PET) which relies on administration of radionuclide isotope that is accumulated by the targeted tissue.

More on Atherosclerosis

Overview: Atherosclerosis
Differential Diagnoses & Workup: Atherosclerosis
Treatment & Medication: Atherosclerosis
Follow-up: Atherosclerosis
References
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Further Reading

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Contributor Information and Disclosures

Author

F Brian Boudi, MD, Clinical Assistant Professor, Department of Medicine, Fellow, Sarver Heart Center, University of Arizona College of Medicine; Adjunct Assistant Professor of Medicine, Mid-Western University; Consulting Staff, Director of Ambulatory Medicine Clinical Rotation, Carl T Hayden Veterans Affairs Medical Center
F Brian Boudi, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Healthcare Executives, American College of Physicians, American Society of Echocardiography, American Society of Nuclear Cardiology, Arizona Medical Association, and Association of Program Directors in Internal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Chowdhury H Ahsan, MD, MRCP, PhD, FRSCAI, Clinical Professor of Medicine, Director of Cardiac Catheterization and Intervention, Director of Cardiovascular Research, Division of Cardiology, University of California Irvine, University Medical Center
Chowdhury H Ahsan, MD, MRCP, PhD, FRSCAI is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Stroke Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Medical Editor

Alan D Forker, MD, Professor of Medicine, Program Director of Cardiovascular Fellowship, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research Center, MidAmerica Heart Institute of St Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Steven J Compton, MD, FACC, FACP, Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals
Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Yasmine Subhi Ali, MD, MSCI, Assistant Professor of Medicine, Director of Preventive Cardiology, Director of Echocardiography, Meharry Medical College; Assistant Clinical Professor of Medicine, Vanderbilt University School of Medicine
Yasmine Subhi Ali, MD, MSCI is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Echocardiography, American Society of Nuclear Cardiology, and National Lipid Association
Disclosure: Nothing to disclose.

 
 
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