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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.
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CT Scan (Computerized Tomography)A 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.
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Percutaneous Coronary Intervention (PCI)Balloon angioplasty of the coronary artery and stents (percutaneous coronary intervention, PCI) is a nonsurgical 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 has expanded the spectrum of patients suitable for PCI.
Coronary Heart 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:
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Heart Attack Symptoms and Early Warning Signs
Recognizing 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) 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.
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High-Sensitivity Troponin Test
The high-sensitive troponin test can detect very low levels of troponin T in the blood. (There are three types of cardiac troponin proteins, I, T, and C.), which helps doctors diagnose a heart attack more quickly.
If troponin levels are elevated high and the ECG (EKG, electrocardiogram) indicates an acute heart attack, immediate cardiac intervention such as catheterization, stents, or a coronary artery bypass graft (CABG).
The high-sensitive troponin test can help diagnose heart conditions such as obstructive coronary disease (CAD), stable angina, congestive heart failure, cardiomyopathy, chronic heart failure, myocarditis, aortic dissection, cardiotoxic chemotherapy, blunt trauma to the chest, and strenuous exercise, for example, endurance athletes.
You can prevent elevated troponin levels in the blood with a heart-healthy lifestyle a heart-healthy diet, maintaining your weight, limit alcohol, don’t smoke, practice stress reduction through stress reduction techniques, meditation, and yoga, manage your blood pressure and diabetes, and take all of your medications as your doctor has instructed you.
Call 911 immediately if you have chest pain and have symptoms of a heart attack, which include nausea, vomiting, belching, indigestion, upper abdominal discomfort that feels like stomach pain in the middle of the upper abdomen, upper back and arm pain, feeling as though you are getting the flu, sweating, a vague feeling of illness, and sweating.
How Is a CT Coronary Angiography Done?Coronary computerized tomography angiography (CCTA) is a heart scan or imaging test that helps diagnose plaque buildup and consequent narrowing of the coronary arteries. The procedure is performed to diagnose many heart conditions, including coronary artery disease (CAD), narrowing of the existing stent, and evaluation of coronary bypass graft patency. CCTA is not invasive and has fewer complications and faster recovery compared to other imaging studies.
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