Heart Disease Expert Forum
CTA
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CTA

Although I'm only 38, I feel like I have very high risk factors for heart disease given my past history of heavy smoking, obesity, and that my father has had about 6 heart attacks starting in his early 40's.   I had a routine stress test last year which was good,  my cholesterol is only 153.

So my question is about calcium scoring.  It is very tempting for me to run down to my local cardiology hack and pay $100 for a scan.   But, I am still gathering knowledge about the info that this can and can't provide.   I am pretty sure I want a scan, but I was wondering such things about the so called "soft plaque" which it cannot detect.    So, given that my cholesterol is only 153, does this mean that I can't have soft plaque in my arteries?   Does the cholesterol measure soft plaque?   What if I get the calcium scan and my score is low --- Then I have a heart attack due to undetected soft plaque?  I guess that is the main thing on my mind, that I will be lulled into a false sense of security.   Is the calcium level usually a marker of soft plaque presence?  (ie-- soft plaque requires the presence of calcium).
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242508_tn?1287427246
Calcium score is a marker that assesses for calcified plaque.  Soft plaque will not be well detected by this modality and you are correct in saying that it is this plaque that predisposes patient to having significant heart attacks.  It is the rupture of this plaque that leads to exposure of subendothelial structures that ultimately lead to clot formation and complete obliteration of blood flow to that part of the heart.  In my opinion, calcium score will quickly fall out of favor in evaluating CAD.  CT angiogram is slightly better because it evaluates for presence of any plaque.  However, contrary to what most think about the relationship of the size of plaque to the development of a heart attack (the larger the plaque the higher the risk) most of the time heart attacks, especially those in younger patients occur in areas of mild to moderate plaque.  So the CT angiogram or even a catheterization can't rule out future heart attacks.  They can only assess for areas of severe obstruction that could potentially explain patients chest pain (not risk of heart attack)  Of course, the higher the overall plaque burden the higher the risk of MI (based on probability).  This would then lead to aggressive risk factor modification and initiation of ASA and beta blocker.  Therefore, given your risk factor profile you should already be on those medications and work on CAD risk factor modification (exercising, eating well, lowering cholesterol to the minimum, not smoking and ruling out diabetes and high blood pressure).  I am not sure that in the absence of chest pain getting any of those test (calcium score or CTA) would be useful at all.  
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Hypertensive Cardiovascular Disease

Can you please tell me what this means in Layman's terms?  This is the cause of death on my father's death certficate.  He was only 51 and I found him on his exercise bike in his basement on March 19th.  I knew it was a heart attack or something and I plan on seeing his doctor to better educate my sister and I on what we're up against for ourselves and our children, but I'm anxious to know now.  I'm also waiting (im)patiently for the detailed autopsy report.  

Thank you so much, it means alot to know.

P.S. he suffered pericarditis when he was 21 and his father died at age 56
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242508_tn?1287427246
Hypertensive cardiovascular disease implies that the heart began to suffer from complications of hypertension (high blood pressure).  Some of those complications are thickening of the heart muscle, valvular disease where the heart valves begin to leak and coronary artery disease where plaque forms in the blood vessels that supply blood to the heart.  These ultimately lead to either progressive heart failure, or as in the case of your father to sudden cardiac death.  The latter is usually related to coronary artery disease.  It sounds like you have sudden cardiac death in your family and should see a cardiologist to further assess and modify your coronary artery disease risk factors.  
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Thank you so much for your input.
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