Cardiac CT

[KeithS]

Last month there was a thread (started by FiameRed) about a cardaic episode one of his riding buddies experienced. It somehow resonated for me. I had a Dr. appointment that week and talked it over with my Doc and he referred me to a Cardiac CT for Calcium Scoring. I got the result this week while on vacation, my Doc tracked me down, that's never good. I had a high score, high score not so good here. 400 is considered high. I'm trying for a record, I came in at 613. Stress test Monday.

Anyone else been through this? I am not asking for any free medical advice, or diagnostics. I am just a bit concerned about prognosis.

By the way, thanks for the post Fiame.

[cadence90]

I've had 2 heart attacks (one month apart) a couple of years ago and now have 3 stents in 2 different arteries. Everything is fine now.

But, to me, it was like an earthquake: completely unpredictable and occuring with no warning at all. The first one was in an airport immigration line, and it just happened...one moment I was feeling fine, the next moment I was on the ground thinking I was going to die. Luckily, because of where I was, there were lots of police, the paramedics were quick, and I was on the ER operating table in under 45 minutes.

45 minutes is generally considered the "safe" limit: minimal damage to the heart muscle occurs during that time; after that, damage acclerates. MI damage is irreversible in the sense that that part of the muscle is dead forever.

My brother (who has more characteristics for a heart attack than I did) now goes to my cardiologist and has a stress test done every year, and also some kind of test done on the arteries in his neck, which I'm told is a prime area for assessing a potential MI.

Skrawny will know more, in specific medical terms.

Is your stress test going to be on a treadmill or will it be via Adenosine injection (which, when you have it done the first time, is a very strange experience)?

As far as concerns re: prognosis, you'll get nothing concrete from anyone other than your own cardiologist.

[hansolo758]

Your calcium score, while certainly over 400, is not the highest I've seen by any means. I've seen calcium scores well in excess of 3000. There isn't a direct relationship between calcium scores and blockages in the coronary arteries, either. While high calcium scores can sometimes mean blockages are present, I've seen people with calcium scores of 1400 have minor blockages, too.

I think you're on the right track. A stress test is reasonable. It might even be normal. Whatever the result, your doctor will want to treat whatever risk factors that favor the growth of blockages, such as blood pressure, cholesterol levels, smoking and diabetes, as tightly as possible. Good luck with the stress test.

[Dekonick]

While I don't know a ton about these particular CT's, I do know that they have caused fear and concern in some who really don't have too much to worry about. I am sure your cardiologist will have you properly tested to rule in/out a serious condition. Regardless, listen to your doctors, not internet wannabe's like me :D

Skrawny is completing his residency in cardiology and should be very up to date on new treatments and tests out there. Perhaps he can guide you a bit.

Dek.

[KeithS]

This just came at me fast. Hansolo kinda guided me to what I was looking for. The number has no meaning, and I haven't had a chance to sit down with my Dr. to discuss any of my concerns. I am planning on taking my physicians advice since I am in some of the risk groups. Cholesterol under control with statin, A1C under 7, diabetes diagnosis 12 years ago. Quit smoking years back, exercise often - riding ~1 hr per day.

My issue is I got the narrative of the reading, I am not a medical professional (nor an amatuer for that matter) and it is a bit difficult to decipher. I think I understand a -17 stem angle, I know I don't really understand the findings of my CT.

To wit: "The patients Agatstson Calcification total score is 613, with just a reading of 1 in the left main, LAD of 265, circumflex 21, and in the right coronary artery of 325." Makes sense to someone, just not me.

Now I am not asking for a discount internet diagnosis based on this dialog. It is just an element of frustration with my healthcare provider when I get this in the mail, and I don't understand if I am afoot or horseback. I have been in the technology business my entire professional career, I understand obfuscation. I will be meeting with a cardiologist on Monday and I ain't leaving until I understand.

Thanks guys! If it wasn't for this place and things I learned here I wouldn't have pressed my Doc to get the CT scan. Something has been found and action will be taken. All positive steps.

Keith

[thwart]

I'm no fan of cardiac CT's.

A likely scenario: You have a score that scares you. You wind up having a stress test that is normal. Your cardiology doc increases your statin dose and starts you on an ACE inhibitor. And perhaps a beta blocker as well.

You feel much less invulnerable---perhaps even anxious---about your health from that point forward.

Technology doesn't always serve us well.

[KeithS]

I got the call while on vacation in Door County, I think I counted heartbeats for a couple of hours. As whiney as that sounds, poor me. You and Hansolo both from the land of cheese, with words of great wisdom. I have a call into on of my closest friends, who has been practicing cardiology in Milwaukee for 20 years. He used to be the chief at St. Lukes.

Enough whining, I'm on my way out to enjoy a beautiful summer morning on my Serotta. By the way there is a great article in today's StarTribune about the Elroy/Sparta and Chippewa Valley trails. Riding in River Falls in a couple of weeks too...

[rnhood]

I often wonder just just how effective a stress test really is. It does'nt pick up blockage unless an artery is 70% or more blocked. Seems like it would be easier and more effective to go ahead and do the catheter/camera probe or, whatever the procedure is called. I know it is higher risk, as any invasive activity is considered high risk but, the results are far more informative in regards to the what and wheres or blockage.

[hansolo758]

Medical testing is often like the poem about the 6 blind men and the elephant. Stress testing, cardiac CT and invasive angiography all give us different views of the heart's circulation. While it's true stress testing cannot pick up some blockages, it can tell us a lot about prognosis. The other tests, even invasive angiography, have their limitations, too.

I agree that medical advice shouldn't be dispensed over the internet and I don't mean to. Proper medical advice should be given, preferably in person, only after a thorough history, physical examination and a review of the testing that has been done. The OP specifically stated he wasn't looking for medical advice -- he had a concern he raised here, as he might have done informally with friends or relatives, and our responses are just what friends or relatives might have offered, no more. If we reassured him that a calcium score of 613 isn't the end of the world, but should be looked into further and not be ignored completely, then we've done what's appropriate.

[KirkKaas]

In August of 05 I suffered a massive cardiac incident, I arrested, needed 6 shocks over a 45 minute period, 45 minutes of cpr and emergency stenting at Virginia Mason in Seattle. I believe had I paid closer attention it might not have happened. I have not ridden since but I have pacemaker now and I am going to start again as soon as I find a bike that I can afford. Listen to your Docs it is better for them to be wrong and over test than for you to be wrong and not test.
I wish you good luckand health.
Kirk

[Skrawny]

With all the usual caveats; beware of advice on the web, only your own doctor can work with you to make decisions, etc... If you believe me, I'm a cardiologist; currently training in electrophysiology.
Here is some (not really asked for) advice:

Don't worry too much.
What that calcium score does is add to any already pre-existing cardiac risk factors such as hypertension, high LDL cholesterol, Low HDL cholesterol (<45), family history of EARLY heart attack, etc.

This score tells me (and should tell you) that you need to be more vigilant. Calcium appears in plaques within the coronary arteries, often before they even begin to narrow. Many people are walking around with plaques, not many people are "lucky enough" to get a warning before they have symptoms or a heart attack.

Coronary angiography is likely not indicated unless you have symptoms (I'm being vague with the word "likely" because it is a decision you should make with your doctor).
A few important facts:
1) Symptoms only really come from lesions that are >70% narrowed
2) As someone already said, stress tests only detect arteries >70% narrowed, AND they are imprecise -with both false negatives and false positives
3) The VAST majority of heart attacks come from lesions that are around 40% narrowed -angiography (the "gold standard") can barely detect these.
4) Placing a stent in an artery will only affect SYMPTOMS and not the chance of MI or death (because of #3, above). Therefore, we only place stents in the ones that are >70% narrowed (#1, above)

If all of this makes you MORE rather than LESS worried, think of it this way: many people over 30 years of age are walking around with plaque in their arteries and don't know they are at risk. We should all be worried.

Given the data you have IMO here's what you should focus on:
Cholesterol goal LDL< 100, optimum less then 70. HDL >50, optimum as high as possible. With medications if need be (likely). Statins maxed out to get to goal, and then Zetia if not at goal yet.
Exercise, weight loss, etc...

I hope this helps some, Feel free to IM me if you have private questions.
-s