Dr. John Francisco Trujillo, MD

Ultrasound is a non-invasive imaging technique that uses sound waves to take pictures of the inside of the body. It is painless and does not use radiation. During a carotid ultrasound, a gel that helps transmit the sound waves is applied to the skin. Then a wand is moved over the skin, sending sound waves through the neck and producing a picture on the computer screen.

A carotid ultrasound is usually performed to diagnose carotid artery disease. The ultrasound can look for narrow sections of artery, plaque buildup, or blood clots that may decrease blood flow to the brain. Plaque and blood clots can potentially break off into the bloodstream and get stuck within the brain, causing a stroke. A specific kind of ultrasound called Doppler ultrasound can detect motion and measure how well blood is flowing. Carotid ultrasound can also be used to evaluate the effectiveness of treatment for carotid artery disease, such as a stent.

Carotid ultrasounds are easy and painless, require no recovery, and provide important information about the health of the neck arteries.

• Angina, which is chest pain that occurs when the heart does not receive enough blood flow.
• Heart attack, which happens if the arteries leading to the heart are completely blocked.
• Arrhythmia, or irregular heartbeat, which can develop if the heart does not have enough blood supply.
• Heart failure, which may occur if a heart attack damages the heart and it becomes too weak to pump enough blood to the rest of the body.

Certain factors may increase risk for the disease, like smoking, lack of exercise, being overweight, high cholesterol, high blood pressure, and diabetes. CAD tends to develop over decades, so it can go undetected until it has become quite severe. A diagnosis may be established using such tests as:

• Electrocardiogram (ECG), which records the heart's electrical activity over a period of time. ECGs can detect whether there is enough blood flow to the heart or if a heart attack has occurred.
• Echocardiogram (echo), which creates images of the heart using sound waves. Echos can show whether the heart is able to pump blood normally.
• Stress tests, where an ECG or echo is combined with exercise, like riding a stationary bike or walking on a treadmill. This test is done to find out if the heart can function properly while performing a strenuous activity.

Treatments for the disease include medications such as vasodilators, like nitroglycerin, which dilates (widens) the coronary arteries. CAD may also be treated by a procedure called angioplasty with stent placement, where a balloon is inflated inside a diseased artery to flatten the plaque deposits against the artery walls, creating more room for blood to flow.

In some severe cases of the disease, multiple arteries may be blocked, and an open heart surgery called coronary artery bypass surgery may be necessary. This operation transplants a vessel from another part of the body to form a graft that goes past the narrowed arteries, thus enabling blood to flow around those arteries.