64 slice CAT

[dpasse]

I am 48 years old. On november 2009 I consulted a Cardiologist for sporadic chest pains during my triathlon training. On examination the ecg was ok but for safety and since I had a race coming up he ordered a SPECT. The result was normal and he said I could continue my life normally. Since then I continued my training and competed in two events, but since the pains continued to appear sporadically, I visited again the doctor, and he ordered an eco stress which I did with effort up to 190 bpm (110% max heart freq), and the result was completely normal. He said that given the results, he reccommended no further test from the heart disease point of view. I insisted that the problem was affecting my life since I am abandoning my sports activity for fear of suffering a serious condition. He told me the next step would be a cardiac cathetherism but he could not reccommend it given the present results, since for me the risks would be greater than the benefits of such a study. I consulted another Doctor and he said I could get a study called a 64 slice CAT, which was less traumatic than a catheterism. On consulting my cardiologist againg, he told me that this study involved an important dose of radiation, and that it has relatively high incidence of cancer induction (>1%), which is the reason why, if he had considered necessary he would go with the cathetherism. Despite his opinion,I have an appointment for the heart CAT scan, but I would like to know another professional opinion on this last issue (radiation and cancer risks involved). Thank you.

[Medavinci]

Hi dpasse,

I have the 64 slice ct every year for my birthday.  My family has a history of heart disease, and to me, this puts my mind at ease.  Another key factor is that i am severely allergic to contrast dye and I would never risk the procedure.  The 64 slice has an accuracy level of 91% in determining if arteries are blocked.  

I had always had good ekg's, stress/echos, etc. until jan 2009 and then suddenly in june 09, my dentist found my bp elevated so I couldn't have a deep cleaning. Immediately,my cardiologist wanted me to take bp meds, and I refused saying I know my body, I want other tests, and if you won't give them to me, I will find someone who will. He reluctantly did a carotid and renal doppler ultrasound.  The nurse berated me (nurse wratched)and said "no one gets those tests unless they've tried 3 different bp meds first and then if your bp doesn't come down, we do them." I didn't care.  I also had my renin and aldosterone tested, and that came back with high aldosterone, and guess what? the  renal doppler showed a blockage in my left renal artery and my the carotid showed a blockage in my left carotid.  I had read that if  you have blockages there, you could have blockages in the coronary arteries as well.  Although the 64 slice shows only calcium, it is a good barometer for whether or not there could potentially be issues.  I've had 6  64 slice ct's and I've had cancer in the past twice.   I have not had any serious incidents from this to date.  

I did see a vascular surgeon in the city, and I came to find out from his doing the renal (he is an expert in RAS and fibromuscular dysplasia - FMD), that I have 80% blockage in the left renal artery and narrowing of the right renal indicating it could be FMD. I have 30% blockage of the left carotid and narrowing of the right (fmd).  However, they need to do a CTA to determine how bad it truly is as it is open to interpretation.  I am fearful because of my dye allergy and he said I need to take prednisone (which I am also allergic to) and benadryl prophylactically to do the dye (and it isn't 100% guaranteed not to cause a reaction).  The dr's up where I am told me the artery is inoperable and I couldn't have angioplasty a) because of my dye allergy but also because the artery is tortuous (looped), but the dr in NYC said any artery can have angioplasty.  You don't know who to believe.  Right now, the bp meds don't work in that they were causing my bp to rise to 250/135.  My normal pressures were 120-130's...but when they went up last year they went to 150's-160's / 100's.   I tried 3 different bp meds and all with terrible thunderclap headaches. The dr in the city said that I was on the wrong class and should be on an ace inhibitor.  I decided xanax would be as far as I would go and to date it works so the only fear is losing a kidney if it keeps shrinking due to lack of blood flow to the kidney.

My question to all the doctors is why can't they use the 64 slice technology, since it is so clear an non-invasive, to look at the kidneys and arteries and why not without dye if they can do so.  It's 2010 and they are still using antiquated tools such as contrast dye which pose such a high risk to patients...

dpasse, I hope all has worked out for you. I know this was posted in April, but do let us know how you made out.  

[kenkeith]

The dose from a CT scanner is if I remember correectly the equivalent of about 21 x-rays...not recommended for younger patients.  The technology has advanced to faster scan with a slice of 320...faster and less exposture better images, etc.  I had a CT scan 120 slice several months ago.  If a doctor approves, there has been a risk/benefit analysis and that opinion may vary.