Atherosclerosis – Part 3

Now that you have your questions and are ready for your appointment, here are some questions that you should expect your doctor to ask. Make sure you have the necessary information.

• Do you have a family history of high cholesterol, high blood pressure, or heart disease?
• What are your diet and exercise habits like?
• Do you or did you smoke or use tobacco in any form?
• Have you had a cholesterol test? If so, when was your last test? What were your cholesterol levels? Some doctors will have the test done before your appointment.
• Do you have discomfort in your chest or pain in your legs with walking or at rest?
• Have you had a stroke or unexplained numbness, tingling or weakness of one side of your body or difficulty speaking?
• What was your last HbA1c? Again your doctor may do the test before your appointment.

During a physical exam, your doctor may find signs of narrowed, enlarged, or hardened arteries, including:

• A weak or absent pulse below the narrowed area of your artery
• Decreased blood pressure in an affected limb
• Whooshing sounds (bruits) over your arteries, heard using a stethoscope
• Signs of a pulsating bulge (aneurysm) in your abdomen or behind your knee
• Evidence of poor wound healing in the area where your blood flow is restricted. This is dangerous for those of us with diabetes and can be the cause of amputations.

Depending on the results of the physical exam, your doctor may suggest one or more diagnostic tests, including:

• Blood tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. You'll need to go without eating or drinking anything but water for nine to 12 hours before your blood test. Your doctor should tell you ahead of time if this test will be performed during your visit.
• Doppler ultrasound. Your doctor may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your doctor gauge the degree of any blockages, as well as the speed of blood flow in your arteries.
• Ankle-brachial index. This test can tell if you have atherosclerosis in the arteries in your legs and feet. Your doctor may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis.
• Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG.
• Stress test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity. Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm and blood pressure and breathing are monitored. In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you're unable to exercise, you may receive a medication that mimics the effect of exercise on your heart.
• Cardiac catheterization and angiogram. This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.
• Other imaging tests. Your doctor may use ultrasound, a computerized tomography (CT) scan, or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls.