We have heard the stories. Your buddy visits his doctor and gets a clean bill of health. Two days later he dies of a massive heart attack. You do not understand how or why this happened. Your friend was active, he played handball regularly, he was thin, and he ate a lot of fish. His cholesterol was a little high but his good cholesterol was very good.  He was taking  a low dose of medication to keep his blood pressure down for about a year and that was working. What happened?

It is true that blood pressure and cholesterol levels can be reliable gauges of how much at risk you are for heart disease. However, the amount of calcium in your coronary arteries and how it is affecting your blood flow may be an even more accurate way of predicting who is most likely to have a heart attack unless they get on medication therapy.

The problem is that someone who is asymptomatic, in good shape and active and eats well is not sending any red flares that something is wrong. Without any symptoms such as shortness of breath or very high blood pressure even with medication, there is no indication that he needs a heart scan, also known as coronary calcium scans. Doctors use heart scans to look for calcium in the coronary arteries and look for blockages.

Heart scans use noninvasive techniques that measure the amount of calcium in the walls of your coronary arteries, the arteries that supply your heart with blood.  One of the goals of cardiac CT for calcium scoring is to determine if coronary artery disease, CAD,  is present and to what extent, even if there are no symptoms.  It is often a screening for patients with risk factors for CAD but no clinical symptoms because having calcium in the walls of your arteries could mean you have coronary artery disease, a major cause of heart attacks. CAD takes place when plaque builds up and narrows your arteries.

The plaques are made of fat, cholesterol and calcium.  It is the calcium in those plaques that the CT scan detects. The CT scan obtains information about the presence, location and extent of calcified plaque in the coronary arteries, the vessels that supply oxygen containing blood to your heart. The amount of calcium that is present is used to calculate a score that, when combined with your other health information, helps to determine your risk of coronary heart disease or heart attack.
The result of this test is often called a coronary calcium score. Heart scans may indicate if you have a higher risk of having a heart attack or other problems before you have any obvious symptoms of heart disease.

However, not all CT scans are useful.  More in my next post. Wait before you ask your physician for a CT scan.  My purpose is to help you understand what your doctor or your spouse’s doctor or your friend may be telling you. You can’t help anyone if you don’t understand what is taking place.

To your successful aging.

Ruthan

Resources: Mayo Clinic, Nov 2008; Radiology Info June,2009

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Filed under: Conditions and Diseases

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