Radiology Medical Group - San Diego, CA


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Heart Disease, Coronary Artery Computerized Tomography & Calcium Scoring: F.A.Q.

What Is Atherosclerotic Heart Disease?
Heart disease is a result of the build-up of atherosclerotic “plaque” along the lining of the blood vessels which supply the heart muscle. When this plaque causes a significant narrowing of the blood vessels, people have symptoms of chest pain or “angina”, because there is insufficient quantity of blood flowing to the heart muscle to supply its needs. Even before this occurs however, the early build-up of plaque puts a person at risk for a heart attack. This is because plaque can be “unstable”, and if it ruptures, the arteries can become blocked, resulting in complete disruption of blood supply to a portion of heart muscle.

Facts About Heart Disease:
Coronary Artery Disease (CAD) is the number one cause of death in the U.S.

What Are The Risk Factors For Heart Disease?

Men 45 or older, women 55 or older
Sedentary lifestyle
Elevated cholesterol levels
Chronically elevated stress levels
Family history of heart disease
Elevated blood pressure
Diabetes
History of smoking

What Is Coronary Artery Calcium Scoring?
Using a state-of-the-art Multislice Spiral CT scanner, approximately 100 x-ray slices are rapidly transmitted through the regions of the heart and the coronary arteries are imaged. Using sophisticated computer software, we are able to image and determine the amount of calcification in the coronary arteries. This allows for a precise quantification of the extent of atherosclerotic plaque build-up, which might exist in the coronary arteries.

Is Coronary Artery Computerized Tomography Risky, Painful Or Time Consuming?
No. The procedure takes less than ten minutes. It is entirely non-invasive, pain-free, requires no needles, and no exercise. The amount of radiation is less than that of a chest x-ray. If you take medications, there is no need to alter your usual prescription (or take any additional medications) for the examination. It is not necessary to fast prior to the scan.

What Does The Procedure Involve?
You will be asked to lie down on your back on the CT scanning table. Since the study is gated, the technologist will place EKG electrodes on your chest. In less than 10 minutes, the examination is completed, and you may resume your normal routine. The radiologist will interpret your images and will calculate a calcium score for your coronary arteries. This score is matched against other people of your gender and age group. This information is then promptly transmitted to your physician.

How Can Coronary Artery CT And Calcium Scoring Reduce My Risk Of Heart Attack?
In order to prevent heart attacks, the first step is to know if you have coronary artery disease. With the information this test provides, your physician will have an understanding of the extent of atherosclerotic build-up there is in your coronary arteries. He or she can then recommend appropriate treatment, including diet and lifestyle changes, medication or further diagnostic testing. It has been shown that these recommendations, when applied to patients early and appropriately, can reduce a patient’s risk of heart attack by as much as 30%!

Table 1: General Recommendations for Calcium Score

Ca Score	Plaque Burden/CAD risk	Recommendations
0	No identifiable atherosclerotic plaque CAD risk: Very low	Healthy Diet (low in saturated fat and cholesterol). Stop smoking. Maintain recommended weight
1-10	Minimal plaque burden CAD risk: low	Above PLUS: Tight control of diabetes and hypertension. Consider use of statins in cases of high cholesterol
11-100	Mild plaque burden CAD risk: moderate	Above PLUS: Estrogen for post-menopausal women. Aspirin use. Use of statins for high cholesterol
101-400	Moderate plaque burden CAD risk: high	Above PLUS: Exercise program. Use of statins in cases of high and borderline cholesterol levels. Consider use of folic acid, vitamin E, fish oils
>400	Extensive plaque burden CAD risk: very high	Above PLUS: Exercise Test to rule out significant narrowing. Consider angiogram for symptomatic patients or those with chronic high stress

How Is Coronary Artery CT Different Than Other Available Tests?

Coronary artery computerized tomography and calcium scoring is the only test that allows physicians to accurately identify which individuals have early coronary disease and quantify how severe it is.
Unlike coronary angiography, this test is completely non-invasive.
Unlike the stress thallium test, this test does not require exercise or pharmacological alterations.
This test permits the physician to modify treatment of those patients with coronary artery disease at the earliest possible stage, before significant plaque build-up or heart attack has occurred.
Up to 2/3 of patients who have a heart attack or angina have only minimal narrowing of the coronary artery. Therefore, physiologic tests such as angiography or exercise stress thallium testing may fail to identify certain patients who are at risk for a heart attack.
A zero calcium score at coronary artery CT scanning is 95-100% accurate in reassuring patients that there is complete absence of coronary artery disease

Table 2: Comparison of Various Diagnostic Methods for Detection of Coronary Artery Disease

Test	Advantages	Disadvantages
Stress Thallium	Ideal for patients symptomatic for chest pain Used to determine extent of heart ischemia	Does not produce images of the coronary artery Significant narrowing must be present to identify ischemia (ie does not detect preclinical CAD
Coronary Artery Computerized Tomography	Noninvasive Detects and quantifies coronary calcification May be used in asymptomatic patients Used to estimate total plaque burden and predict risk of future events Normal study excludes CAD with near 100% accuracy	Does not identify specific areas of narrowing of coronary arteries. No universally defined treatment plans for positive test results
Coronary Angiography	“Gold Standard” Images coronary artery Shows number of diseased vessels and identifies narrowed segments Useful to plan angioplasty and bypass	Invasive Expensive Reserved only for patients with high suspicion for coronary artery abnormalities Not used to screen asymptomatic patients to predict risk of future events

Is Coronary Artery Disease Treatable?
Yes. The plaque build-up process can be slowed, stabilized and reversed through dietary and lifestyle modifications and through appropriate medical regimens. This must be done with the guidance of your physician.

Who should undergo coronary artery computerized tomography?
Based upon through review of the medical literature, coronary artery computerized tomography provides useful information for the following patients:

Anyone who is at high risk for coronary artery disease based on known risk factors (see above) Men age 40 or greater and women age 45 or greater with a positive family history and/or elevated cholesterol levels. Patients who have symptoms of “atypical” chest pain with an equivocal stress electrocardiogram Patients who are on cholesterol-reducing medications, or who are on exercise and nutrition therapies. For these patients it is useful to follow the progression or regression of coronary artery disease and modify treatment accordingly.

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