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What is a CT coronary angiogram?
A new test is available to diagnose coronary artery disease. In the past, noninvasive functional tests of the heart were used, such as treadmill tests and nuclear studies, to indirectly assess if there were blockages in the coronary arteries. The only way to directly look at the coronary arteries was via a cardiac catheterization and coronary angiogram.
CT scans have been used to look at various anatomic regions, but have not been useful for the heart because the heart is continuously in motion. CT is very effective in looking at "static" areas, such as the brain, abdominal cavity, and extremities. Most early CT scanners take 1-8 pictures (slices) a minute, much slower than the rate of the heart. Just as taking a picture of a moving object with a camera results in a blurry picture, conventional CT scans of the heart are not helpful. A new generation of CT scanners which can take 64 pictures a minute is now available; with the use of a little medication to slow the heart rate to less than 64, CT images of the coronary arteries are now possible.
How is CT coronary angiogram performed and what are the risks of the procedure?
This procedure use intravenous dye which contains iodine and CT scanning to image the coronary arteries. While the use of catheters is not necessary (thus the term "noninvasive" test applies to this procedure), there are still some risks involved. In people allergic to iodine, pretreatment with medications is necessary to prevent allergic reactions to the dye. In people with abnormal kidney function and/or diabetes, the dye may worsen kidney function. Finally, there is radiation exposure which is similar to, if not greater than, that received with a conventional coronary angiogram. Nonetheless, this is generally a very safe test for most people, but should only be undergone when ordered by a physician familiar with the patient and their underlying medical condition.
Who should get a CT coronary angiogram?
While CT angiography should not be used as a "screening" test in the general population, it is a major new tool in the diagnosis of coronary artery disease. In patients at high risk for developing coronary disease (cigarette smokers, those with genetic risk, high cholesterol levels, hypertension, or diabetes), who have unclear results with treadmill or other testing, or who have symptoms suspicious of coronary disease, CT angiography is an excellent next step in the diagnosis. If the CT scan is normal or only mildly abnormal, it makes the likelihood of a severe blockage of the coronary arteries extraordinarily small. Conversely, if the CT scan is significantly abnormal, cardiac catheterization and angiography are then indicated, to see if angioplasty, stenting, or coronary bypass surgery may be indicated.
In people who have had bypass surgery, CT angiography is very effective at evaluating the patency of the bypass grafts. In people who have had coronary stents , it is sometimes difficult to image the inside of the stent to see if it is narrowed. Due to these complexities, while CT coronary angiography is an exciting new modality, it is imperative to discuss with your physician if this is the correct test for you. As more experience is obtained, the indications for the test will become even clearer.
Quick GuideHeart Disease: Causes of a Heart Attack
Healthy Heart Resources
"Noninvasive coronary imaging with cardiac computed tomography and cardiovascular magnetic resonance"
uptodate.com. 17 Mar. 2015.
Top CT Coronary Angiogram Related Articles
Angina SymptomsAngina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
Aorta PictureThe aorta is the largest artery in the body. See a picture of the Aorta and learn more about the health topic.
CAT ScanA CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
Congestive Heart Failure (CHF) OverviewCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Coronary AngiogramCoronary angiogram is an angiogram (an X-ray image of blood vessels filled with contrast material) used to diagnose coronary artery disease responsible for heart attacks, strokes, angina, and other coronary artery diseases. Coronary angiogram assists the physician in diagnosing and recommending treatment for coronary artery disease.
Coronary AngioplastyBalloon angioplasty of the coronary artery and stents (percutaneous coronary intervention, PCI) is a non-surgical procedure that relieves narrowing and obstruction of the arteries to the muscle of the heart. PCI can relieve chest pain (angina), minimize or stop a heart attack, or improve the prognosis of patients with unstable angina. The availability of stainless steel stents have expanded the spectrum of patients suitable for PCI.
Coronary Artery Disease Screening Tests (CAD)
Coronary heart disease or coronary heart disease (CAD) screening tests can be used to potentially prevent a heart attack or cardiac event in a person without heart disease symptoms, and can assist in diagnosing heart disease in individuals with heart disease symptoms. Examples of coronary heart disease tests include:
- electrocardiogram (ECC, EKG),
- exercise stress test,
- radionuclide stress test,
- stress echocardiography,
- pharmacologic stress test,
- CT coronary angiogram, and
- coronary angiogram.
Heart Attack Symptoms and Early Warning SignsRecognizing heart attack symptoms and signs can help save your life or that of someone you love. Some heart attack symptoms, including left arm pain and chest pain, are well known but other, more nonspecific symptoms may be associated with a heart attack. Nausea, vomiting, malaise, indigestion, sweating, shortness of breath, and fatigue may signal a heart attack. Heart attack symptoms and signs in women may differ from those in men.
Heart Disease (Coronary Artery Disease)
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include:
- High blood pressure
- High cholesterol
- Family history
Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
CAD SlideshowWhat is heart disease (coronary artery disease)? Learn about the causes of heart disease. Symptoms of heart disease include chest pain and shortness of breath. Explore heart disease diagnosis, treatment, and prevention.
Heart Disease SlideshowLearn about heart disease and heart attack symptoms and signs of a heart attack in men and women. Read about heart disease diagnostic tests, treatments, and prevention strategies.
Heart: How the Heart WorksThe heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.
Pulmonary EmbolismA pulmonary embolism (PE) occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate. Causes of pulmonary embolism include prolonged immobilization, certain medications, smoking, cancer, pregnancy, and surgery. Promt medical attention should be sought if you think you or someome you know has a pulmonary embolus.
Take the Stroke QuizTake the Stroke Quiz to learn about stroke risks, causes, treatment, and most importantly, prevention.