Computed Tomography or CT Scan
This is a non-invasive scan using X-Ray technology to produce images of structures inside the body. Here at CVI, we may now perform CT Scans right here in our office of all bodily structures including the heart without the delay and the added cost associated with hospital or testing facility services.
CTA or CT Angio provides imaging of the vessel pathways as well as the structure of tissues and organs in the body. For this test, patients will have IV administered contrast timed to scan the target body part so the vessels will be imaged when the contrast is present. This will render a 3D image of the vascular tree of the target organ or area that will be used to diagnose or confirm disease.
Coronary calcium scan (heart scan):
What is a heart scan? It is a specialized CT scan of your heart, which enables us to detect the buildup of calcium-containing plaque inside the arteries of the heart. Plaque buildup inside the artery disease indicative of atherosclerosis. Atherosclerosis contains calcium from previous inflammation. This buildup of plaque can cause angina because it restricts the flow of blood in the artery. However, more ominously, the plaque can rupture, and the blood that flows inside that artery attempts to seal the rupture in the plaque and forms a blood clot. This blood clot catheterization suddenly worsen angina symptoms and chest pain, or occasionally, can seal the artery off completely, resulting in no flow in the artery, and that is called a myocardial infarction or heart attack. Therefore, a heart attack occurs at the site of plaque rupture that results in a blood clot (thrombosis) of the artery. Hence, 1 of the treatments used for the management of heart attack is a clot buster called TPA. Progressive narrowing of the artery due to plaque formation results in the restriction of the flow of blood to the muscle of the heart and causes chest pain called angina. Therefore, having hardening of the arteries is the same as having a calcium buildup in the walls of the arteries. This plaque buildup is a major risk factor for angina, heart attack, and sudden death. The amount of plaque is proportional to the calcium amount. Therefore, the higher the amount of calcium, the greater the amount of plaque in the arteries. Hence, the coronary calcium scan quantifies the amount of calcium that you have, gives it a number, and the greater the number, the greater the risk to the patient. Hence, the test will allow patients to be identified at very low risk, low risk, moderate risk, and high risk. Once identified, appropriate preventive measures can be implemented to prevent the progression of plaque buildup and calcium buildup, and avoid rupture of the plaque.
Who should get it done? It is predominantly indicated in patients in the intermediate risk patients. However, that definition is still very vague. If the patient has risk factors for atherosclerosis such as pre-hypertension, hyperinsulinemia, hypertension, dyslipidemia, sleep apnea, history of smoking, increased body mass index, very sedentary lifestyle, inflammatory skin conditions, inflammatory bowel disease, peripheral vascular disease, history of stroke, and a history of previous myocardial infarction are typical examples of patients expected to have atherosclerosis, and the coronary calcium score that is elevated.
What does an elevated calcium score mean? It means that this patient already has atherosclerosis, and the larger the amount of plaque, the greater the calcium score. He calcium score over 400 is extremely high and places the patient at high risk of developing angina, myocardial infarction, congestive heart failure, and arrhythmias in the future.
Can the calcium score come down? There are few studies demonstrating drastic reductions in calcium score. Most, demonstrate a mild drop with stabilization with no further increase in the calcium score on repeated studies performed at 24 months. Aggressive lifestyle changes, dietary changes, improve nutrition, can stabilize the progression. Calcium scores in general increase over time, hence we know that those who have had a heart attack before, are most likely to have another one. Finding a high score means looking for as yet undefined and untreated risk factors. For example, one of the main factors that result in in the progression of the disease is hyperinsulinemia, and the insulin levels can only be measured in the blood test and are done very infrequently. Dr. Jamnadas is a strong proponent of measuring insulin levels, and if elevated, implement powerful dietary interventions to reverse hyperinsulinemia and thereby reduce cardiovascular risk. If serial levels of calcium scores are stable, the patient is at low risk of future events, even if the calcium score is high.
How is the coronary calcium scan done? You do not have to fast for this test. However, he should avoid caffeine and smoking for at least 4-6 hours prior to the test. Your heart rate needs to be slower, and occasionally, you will require an intravenous injection or a tablet of a beta-blocker to slow the heart rate to obtain a more accurate scan. You will be asked to remove the clothing above the waist and wear a medical gown, remove all the jewelry around your chest, EKG electrodes will be applied to your chest, and you will I on the x-ray table for approximately 5 minutes. The scan is tolerated by even claustrophobic patients because your ahead will always be outside the scanner. You may be asked to hold your breath for a few seconds, and the entire scan procedure should take no more than 15 minutes.
When do I get the results of the coronary calcium study? The images are processed, and usually available the next day. This calcium score for each artery is determined. The total score represents the calcium buildup in all the coronary arteries. The greater the score, the greater the risk of cardiovascular complications in the future. It is probably the most predictive test for the cardiovascular disease currently available. A score between 0 and 100 is already abnormal, and puts you at an increased risk but, still requires risk factor modifications. A score in excess of 400 places you at very high risk, and depending on your symptoms and other factors, you may require further investigation into the physiological effects of the plaque buildup using a nuclear stress test. We always encourage the scan result to be discussed in detail with the doctor and his assistants, and further recommendations will follow. A 0 score places the patient at very low risk of future cardiovascular events, and may even allow discontinuation of some medicines.
The coronary calcium scan has been underutilized for more than a quarter century, mostly because of a lack of understanding of the usefulness of this test. It is the most direct way to establish a diagnosis of coronary artery disease, and risk stratifies the patient for future risks of heart attacks, death, and other forms of heart disease. Unfortunately, insurance companies and some medical organizations have not supported their use for dubious reasons. Knowledge of the coronary calcium score can be a very strong motivating factor for lifestyle modifications, dietary changes, stress management, and pharmaceutical interventions. Most cardiovascular events come unannounced and do not give the patient an opportunity to have avoided the event with simple preventive measures. Our modern lifestyle habits can be clearly detrimental, and lead to coronary atherosclerosis, yet, we are led to believe that we are leading a clean, healthy lifestyle and diet. Hence, the first cardiac event comes as a shock. Knowledge of the coronary calcium scan result can result in changes through education and avoiding the trap of social indoctrination about what really constitutes a healthy lifestyle and diet. When most patients are asked about their lifestyle and diet, most feel that it is quite good based on their past knowledge and what they have learned from the social structure. This is often slanted by the food industry, advertising, misinformed advisors, and upbringing. There is an ever-growing threat of cardiovascular disease, and the coronary calcium scan is an early signal of alarm and a call for action. Coronary artery disease and atherosclerosis is a predominantly preventable disease. It starts as silent coronary calcium buildup, and then years later, if no corrective action plan is implemented, results in severe morbidity and mortality. It is the #1 cause of death in the United States and much of the Western world.