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The assessment of new onset chest

pain can be challenging. It is stressful

for patients with the potential

sequelae of the diagnosis of significant

coronary artery disease and the

resultant consequences. It is important

to reach the correct diagnosis rapidly

and not to miss a presentation of

potentially significant coronary

artery disease.

Invasive coronary angiography,

the gold standard for the detection

of coronary artery disease, provides

anatomical rather than a functional

assessment of coronary

artery disease. It has

a small but significant

risk of important

complications. To

address these issues,

several non-invasive

functional tests have been

developed for the assessment

of chest pain. These investigations

have now virtually replaced routine

treadmill exercise testing in patients

with chest pain. Patients with a

low-risk factor profile will generally

require a CT coronary angiogram.

Those with slightly higher risk usually

require some form of functional

non-invasive cardiac imaging. This

can be either nuclear imaging, cardiac

MRI (also known as CMR) or stress

echocardiography.

Cardiac MRI offers a safe method to

assess the majority of these patients.

Unlike nuclear imaging, the patient

does not receive ionizing radiation.

Images are readily obtainable in

most patients in a 30-minute

assessment. Cardiac MRI offers the

most accurate assessment of left and

right ventricular function. It allows

for direct visualisation of myocardial

scarring or fibrosis, such as previous

myocardial infarction. Detection of

significant coronary artery disease

is performed using adenosine stress

perfusion imaging. Cardiac MRI is

safe and well-tolerated by almost all

patients. There are regular weekly

Cardiac MRI sessions at London

Bridge Hospital including stress

perfusion imaging.

Use of Non-

Invasive Cardiac

Imaging in the

Assessment of

Chest Pain

Dr MarkWestwood was

educated at St John’s College,

Oxford and St Bartholomew’s

Hospital, London. His interest

in Cardiac MRI (CMR) started

in 2001 with his MD thesis

on CMR. He has been a

Consultant Cardiologist at

The London Chest Hospital

for three years. During this

time as Lead Clinician for CMR

at The London Chest Hospital,

he has initiated, set up and

developed the CMR service

into one of the largest UK

CMR services, with a particular

focus on the assessment

of coronary artery disease

with the use of CMR stress

perfusion.

He is a Board member

of the British Society of

Cardiovascular MRI. He

co-founded ‘London CMR’,

the first UK clinically focused

CMR meeting and now

the second largest. He was

central to the development

of the training programme

for cardiology trainees in the

UK and is involved at national

and international level in

the delivery of training and

education in CMR.

Dr MarkWestwood is available

for outpatient consultations

at 31 Old Broad Street, every

Thursday afternoon.

Non-Invasive Cardiac Imaging

SIX

Non-Invasive Cardiac Imaging

Dr Mark Westwood

Consultant Cardiologist

31 Old Broad Street

Secretary: Michelle Luck

T: 020 7234 2939

F: 020 7234 2988

[email protected]

co.uk