64 slice ct coronary angiogram - scared

[tomah]

53 yr old female, former smoker, cholesterol 118, HDL 27,Trig 99,VLDL 20, LDL-CAL 71, overweight, cannot exercise due to shattered bones in foot.  Had new 64 slice ct coronary angiogram.  Cardiologist that read the report stated that he is new at reading this (hospital has only done the tests on paying patients for 1 week).  He reported RCA; technically a dominant vessel which is free of significant disease in its proximal course.  in its mid course it tapers off into small vessel that give off a right ventricular branch.  Immediately after right vent. branch, right coronary artery appears to be completely occluded.  The PDA is seen to fill PROBABLY via left sided collaterals especially the first obtuse marginal branch.  He did say that he is not certain of the blockage and may be seeing muscle.  Calcium score was 3 - small degree of mild sof plaquing along with specks of calcium in LAD - proximal to the takeoff of the first diagonal brnach.  Sof plaue is nonocclusive.  Rest of LAD is small but free of significant disease.  All other vessels/arteries free of soft plaque and calcium.

Cardio doesn't feel angiogram is warranted at this time.  Patient on Toprol 50mg 1 x day, asprin 81 mg 1 x day, Lipitor 10 mg 1xday.  ER cardio suggested that this blockage may have happened years ago. Patient is non-symptomatic. EKG & blood tests normal.


What tests do you think would be warranted for an total blockage?
What risks is this blockage for future heart problems?
How unusual would it be for a calcium score of 3 to have this significant blockage?

[Cleveland Clinic]

tomah,

The cardiac CT is an exciting new technology. However, it really still is in its infancy with respect to how to use it to guide therapy. For now, I personally use it as a screening tool for coronary artery disease, which it has diagnosed in you.  Also, the occlusion of the RCA with collateral vessels from the left, may not be completely accurate, as cardiac CT may miss a collateralized vessel that is almost completely occluded.

The next step is a difficult one. I generally guide my therapies and interventions based on the presence or abscence of ischemia or symptoms. The CT doesnt tell you anything about the former, and your inability to exercise makes gauging the latter difficult.

With respect to your quesitons:

1) What tests do you think would be warranted for an total blockage?

Either an angiogram or a stress test to look for ischemia depending on how invasive you would want to be.

What risks is this blockage for future heart problems?

The presence of coronary disease is a marker for increased risk for cardiovascular complications. The goal for you would be to lower that risk as much as possible through strict control of your cardiac risk factors.

How unusual would it be for a calcium score of 3 to have this significant blockage?

The calcium score is a marker for coronary disease. Some people develop more calcium in their atherosclerotic plaques than others. I wouldnt give this finding too much thought.

good luck

[andie3330]

Can you possibly have a second doc read your CT scan? I think this is a case where previous experience in CTA is extremely important. Maybe you could have your CT sent to a facility that has been doing the procedure longer. I'm scheduled to have a CT angiogram this comming week and I'm pretty nervous about it. Did you take a beta blocker or have a sedative before the test?

[tomah]

Do you take beta blockers?  They told me to take two before I came for the test.  If your heart rate is still too high, they will give you more when you get there (they want it below 60).  The test is nothing - doesn't hurt, doesn't last long.  They do inject you with a contrast - and that will make you feel warm for a minute or two.  Hope you have better luck with your test, than I did with mine.  I'm still trying to find a second dr. to read it, but no other cardios want to read a test that wasn't done at their facility by their own technicians!

[kraus]

I am 60 years old. Father died at 58 of heartattach, grandmother at 48, greatgrandmother at 65, cousin at 50, aunt at 64. No one ever survives to diagnosis the problem. I have a been having a great deal of chest pain in the left quadrant and left arm.I also have a great deal of dizziness. I have had several false positive treadmills and the doctors say I should not worry about it. I have felt really bad over the past 6 months and extremely tired. I had a treadmill last Monday, and before the test, the nurse said I looked bad (coloring in the extremities were puzzeling to him. My left arm was a little darker than the right arm. He proceeded with the treadmill, and after a couple of minutes, I had a sharp pain in my chest, and I guess it showed up on the ekg. He immediately stopped the treadmill and had me lay down for about 6 minutes. He and the doctor discussed the problem outside the room. I had previously had a Calcium screening about a year ago, which I paid for on my own. The Left Main calcium score wa 4.62, the Right Coronary artery was 2.77. The Volume Score was 9.94mm. The Percentile Ranking was 57.26%. I gave the complete report to the nurse to show the doctor, and the nurse said that the doctor did not know how to read it. They latter called me in and the doctor, (which was not a cardiologist said I did have a blockage and wanted to put me on Atenolol. I told her that in the past that it dropped my blood pressure really low, and could we try something else. She gave me Isosorbide Dinitrate 5 mg. I asked her if I could see a cardiologist because of my family history and the fear. I later saw a cardiologist, who told me not to take the medicine, that it was a false positive treadmill, and that if I were worried, I could have an angiogram. He said just because my father and other relatives had a heart attach was of no concern; if it was both parents, then I should be concerned. I asked for a CT Scan first. He said "No" it was too expensive and took too much time. He then proceeded to tell me about how dangerous the angiogram could be. I again asked him for a CT Scan. Again, he said no--too expensive and takes too much time. I belong to Kaiser and they do not have the 64-Slice CT Scan. I found one hospital in Redwood City, California that does it for $1500. Would this be a beneficial thing to do. No one in my family even makes it to the hospital. The heart attacks kill them before they ever get to the hospital. Any input would be greatly appreciated.My husband and I just want some peace of mind and don't mind paying the money.

[dmil241]

I am not a doctor and this is just my opinion. However with your family history, I would be very concerned! I think I would even find another cardiologist who took my family history more seriously. I am only 42 and only my father has had a heart attack right at age 55 and my cardiologist takes this serious when considering my own symptoms. He ordered a 64slice CT scan for me a couple of months ago which turned out very positive. I'm not sure if you need an angiogram or a 64slice CT but it seems like one of them needs to be done. A 64slice CT would only show if you had blockages. They might still need to go in and stent or something. If you had the angiogram and they found blockages, they could do something right then and there. ??? Just something to think about

[Dasobel]

Go see another cardiologist immediately and get a second opinion.  Your symptoms are very serious and troubling.  Whether an angiogram is necessary or not is for your physicians to decide, but based on your description, I would be extremely surprised if some form of further testing (CT, thallium, stress-MRI, whatever) was not indicated. It does not sound as if the physician who did your treadmill test had the right experience and background. Don't mess around. If you have a problem, there are so many things you can do to address it and live a long, long life!  But you have to know what you're dealing with first, and there's no reason not to check this out to the fullest extent available and recommended.

[shinny]

Hi all,

Do follow up on this, if only for peace of mind.  We don't have to take what some Dr's/Consultants tell us.  It's your life, not theirs & if you are in any doubt, don't give up!!

I'm very interested in this 64 Slice CT.  I don't think we have it here in Ireland, but I'd love the chance to get it done.  Just to see what's going on with my heart !!

I saw it on Oprah Winfrey, very exciting, but as the Dr said early, very much in it's early stages.  They need to understand what they are looking at.  Some people have small blockages that will never effect them. Others have blockages in certain areas that will cause a massive heart attack & they will die immediately.

As a matter of interest, how much does it generally cost to get done ?

Good Luck Tomah, let us know how you get on !