Simple questions are often the hardest to answer. In this case, blockage of coronary arteries, also called stenosis, can be a challenge to diagnose. The best imaging technique currently available is called coronary angiography. This invasive procedure involves puncturing the skin and a large blood vessel, usually the femoral artery in the groin area. A small wire is then advanced through the puncture hole towards the heart. Various catheters (tubes) are then passed over the wire – the procedure is also called coronary “catheter”ization. Through these catheters, contrast dye is injected into the coronary arteries and x-ray pictures are taken to find stenosis.

Although coronary catheterization is very accurate, it carries some risk. There can be pain, infection, and bleeding at the puncture wound. More serious complications such as heart attacks and stroke are rare. Non-invasive, and less risky techniques are also available. For example, imaging the heart with sound waves called ultrasound is called echocardiography. This valuable test evaluates can tell if an area of the heart is not moving and may not be getting adequate blood flow through blocked coronary arteries.

Another non-invasive imaging technology uses a nuclear camera. This technology involves a small amount of radiation is injected into a vein through an IV. The radiation is picked up by heart muscle. The nuclear camera determines which areas of the heart get good flow by measuring the amount of radiation in the muscle.

A new non-invasive technology is CT angiography. This utilizes x-rays and contrast dye much like invasive angiography. The pictures are very accurate and may become a leading source of information for patients and doctors in the near future.