There are three key tests currently used to diagnose<unk> s by Stanford University: CT scan, cardiac catheterization, and stress ultrasound. # CT scan - on which the<unk>  often appears as a compressed or squashed area of the artery in which, notably, the fatty areas surrounding the artery (shown in black on CT scans) disappear, since the artery is tunneling through muscle not fat in this area. CTs often allow an assessment of an approximate length and depth of the<unk> , but compression cannot be assessed accurately from a CT scan. # IVUS cardiac catheterization including dFFR measured during dobutamine challenge - from which readings of dFFR and percentage compression as well as measurements of the approximate length and depth (shown as the halo or echolucent band) of the<unk>  are taken. It is critical to note that in order to be meaningful in diagnosing a<unk> , it is critical to measure dFFR i.e. the diastolic period, not mean FFR. This is because, contrary to a common misconception,<unk> s cause compression of the artery during diastole as well as systole, as explained above. This has been shown in multiple studies. It is also critical that the dobutamine challenge be used, elevating the heart rate, because dFFR decreases significantly at high heart rates as shown by Yoshino et al., 2014. # Stress echocardiogram (i.e. before and after running on a treadmill) - used to identify evidence of ischemia i.e. a lack of oxygen delivered to the ventricle due to the<unk> . This test does not visualize the<unk>  itself but rather its effects on the ventricle. Multiple studies have shown that ischemia from<unk> s is indicated by the appearance "septal buckling" in the stress echocardiogram, as the septum gives out under stress., which a 2013 paper by Lin et al. describes as "a transient focal buckling in the end-systolic to early-diastolic motion of the septum with apical sparing which correlates prospectively with the presence of LAD<unk> ." As much of the science of testing for<unk> s is relatively new, patients frequently go undiagnosed. Stanford's center for<unk> s has offered second opinion services from a distance for some ten years, including to numerous international patients. Notably, EKG is not a reliable or conclusive diagnostic tool for diagnosing<unk> s. Some symptomatic<unk>  patients show normal EKG results and others abnormal. Many doctors have suggested that there is a need for more awareness of<unk> s among doctors and better testing, including testing of young people as the disease is congenital. According to a 2007 study by Ripa et al.: "Clinical suspicion of a<unk>  would be warranted in all cases of typical or atypical chest pain in subjects who have a low probability of atherosclerosis because they are free from the traditional cardiovascular risk factors, particularly in the young." In a 2017 article in Stanford Medical Center's official blog Scope, Dr. Ingela Schnittger stated: "Many of these patients have these heartbreaking stories to tell. They can’t hold a job, they can’t travel, they can’t take care of their families. Most cardiologists are completely at a loss. They know<unk> s exist, but they have been taught they are benign and never cause problems... When these patients go to the ER, and they go there a lot, all the cardiology tests come back normal. They’re told, 'Here’s a little Valium. I think you’re anxious.' They get belittled, not taken seriously, and they get really depressed."
Myocardial bridge
Myocardial disarray
Hypertrophic scar
Contraction band necrosis
Buddy wrapping
Infibulation
Blunt dissection
Dural tear