Treadmill, stress echocardiography, Thallium and Angiography do not detect early blockages. Treadmill can miss blockages up to 70 percent; stress echocardiography up to 60percent, angiography up to 40 percent. Most heart attacks occur because of a plaque rupture in patients with blockages of less than 50percent. If the blockage is more than 70percent the patient usually presents with heart pain and not massive heart attack. The only way to detect heart blockages before they cause symptoms or are detected in conventional tests is to measure the wall thickness of the neck artery or the leg artery. Normally, the wall thickness is less than 0.5mm. If the wall thickness is more than 0.75mm, it is suggestive of underlying heart blockages and if it is more than 1mm, it is suggestive of blockages in all three arteries of the heart. Any thickness of more than 1mm is called as a plaque and a plaque area calculated by high resolution ultrasound is a new marker for heart blockages, progression as well as regression. If the artery wall is thick in both the neck artery and the leg artery, it is very likely that the patient will also have blockages in the arteries of the heart. All high risk individuals, therefore, should have their neck and leg artery wall thickness check-up done. Only 2percent of patients with blockages in all three arteries of the heart have a neck artery wall thickness of less than 1mm and 94 percent of patients with a neck artery wall thickness of more than 1.15mm will have multiple blockages in the heart. Most heart blockages are inflicted in adolescence and early adult age. There is enough data to suggest that thickening of the neck artery starts in high risk children and very young people. Plaque formation usually occurs after the age of 35. Therefore, before the age of 35, a leg artery wall thickness is the only test to know future chances of heart attack and paralysis. With the availability of advanced software, most advanced cardiac centres in Delhi with high resolution echocardiography machine can do this test. Women with chest pain and normal neck artery morphology may not need angiography and a neck artery wall thickness test of less than 0.55mm is also a predictor of patient’s significant blockages in the heart. A plaque thickness of more than 1.5mm is associated with family history of premature cardiac deaths.

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