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calcification of arteries
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calcification of arteries

Should I be concerned about a CT Scan that shows 30% blockage of arteries?  I have a family history of heart disease on my mother's side of the family.  Almost all of her brothers and sisters have had heart attacks and blockage.  I would like to know if there is any other tests that I should have done at age 48?
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976897_tn?1379171202
Well that is a very difficult question to answer, mainly because you don't know the composition of the blockage. I would definitely make some changes in your life now. If you smoke, quit. If your blood pressure is high, have it treated. Get on a healthy diet and if your cholesterol is still average, think about statins. Exercise regularly, and try to avoid stress as much as possible. It is important you make these changes now, to avoid progression of the disease. I read about some patients the other day where they had lesions which more than doubled in size over a period of 50 weeks to just over a year. It depends on the type of composition of the blockage.
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367994_tn?1304957193
You are in a category that a CT scan may provide useful information.  Usually the CT score provides useful information if there is or how extensive of  any coronary artery disease.  Helpful to those with a higher than normal risk such as a family history....may be grounds to begin early treatment. The CT score calculates the amount of soft plaque within the linings of the vessel.  It is refered to as soft plaque and presents the highest risk for a heart attack. The soft plaque breaks through the inner lining causing a blood clot and that can can completely block coronary blood flow and cause a heart attack. The "score" provides a calculation of the amount of soft plaque and the risk for a heart attack is assessed. There is a different etiology for hard plaque as that condition reduces blood flow and when advanced can cause heart failure (heart not receiving enough oxygenated blood).

You probably just had an angiogram that viewed the inside of the vessel.  The 30% blockage doesn't provide much information of how advanced CAD may be, but it does indicate a minor development of hard plaque that occludes the artery and reduces blood flow. Almost always there are no symptoms until blockage is 70% or greater, and medication then may be the therapy, sometimes a stent or bypass.

I have had a CT scan score, and for me it shows advanced CAD, but medication for the past 7 years have prevented any progression.

Thanks for your question and if you have any further questions or comments you are welcome to respond. Take care and I wish you well going forward.

Ken


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976897_tn?1379171202
"The CT score calculates the amount of soft plaque within the linings of the vessel"

It's the other way around. What it detects is the calcified plaque, not the soft vulnerable plaques. This is why Europe is currently favouring CTA over CCS. Over 80% of plaque in the coronary tree can be soft vulnerable plaque and CCS will only see 20% of the remaining calcified plaque.
There are basically three stages. Macrophage development into foam cells where they are filled with fat (non calcified and non CCS detectable). Partial Macrophage (foam cell) calcification, so we end up with a mixture of both calcified and uncalcified (CCS will only detect the calcified percentage) and lastly the total lesion of calcified plaque which CCS will detect all of it. CCS can be a good estimation tool if you take into account many other factors which require a lot more work yet, such as ethnic origin, age, sex etc.
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367994_tn?1304957193
Incorrect from my understanding. A significant number of patients who suffer a heart attack never have any warning signs. For many of these individuals, the source of the problem is noncalcified plaque, a buildup of soft deposits embedded deep within the walls of the heart’s arteries, undetectable by angiography or cardiac stress tests – and prone to rupture without warning.

“The importance of quantifying plaque is critical because total plaque burden is considered the most important predictor of coronary events,” explains the study’s senior author Melvin Clouse, MD, PhD, Emeritus Chairman of the Department of Radiology and Director of Radiology Research at BIDMC and Deaconess Professor of Radiology at Harvard Medical School. “Furthermore, the rupture of soft noncalcified plaque has been implicated as the cause of heart attack"

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976897_tn?1379171202
OK, now you've lost me. Can you please re-read my post. I don't disagree with anything you just posted. I just said a CCS doesn't see soft vulnerable plaque.

Here's the crunch. Different lesion types, depending of their composition, pose a different risk level. Let's say you have 2 patients go for a CCS. They both have the same score. One has lesions with thin calcified plaque covering abundant vulnerable plaque. The other has the same level of calcified plaque but it's thicker, covering less vulerable plaque. One has much more risk than the other, yet the results are the same. How can this be valuable.
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Avatar_m_tn
The only thing I know by now is that CAC - Coronary Artery Calcium - will not detect soft plaque. How could it? Soft tissue is transparent to X-rays. However CTA - CT Angiograhy will.
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367994_tn?1304957193
Aditionally on the upside of calcium scoring: Exercise stress testing and coronary angiography, the standard methods for diagnosing atherosclerosis and heart attack risk, both work by visualizing the lumen, the channel through which blood flows.

However, because the lumen also increases in size as plaque progresses, coronary artery disease may go undetected until late in the disease process. And, adds Clouse, “Because soft plaque buildup may not significantly narrow the lumen, conventional angiography and stress tests fail to provide a complete picture of plaque accumulation.”

Exercise stress testing and coronary angiography, the standard methods for diagnosing atherosclerosis and heart attack risk, both work by visualizing the lumen, the channel through which blood flows.

As I have stated on previous occassions there can be  positive remodeling of the vessel with soft plaque...this is an increased risk with just an angiogram. It is the result when the lumen also increases in size as plaque progresses, coronary artery disease may go undetected until late in the disease process. And, adds Clouse, “Because soft plaque buildup may not significantly narrow the lumen, conventional angiography and stress tests fail to provide a complete picture of plaque accumulation.”

I know about about foam cells, etc. that is irrelevent.  New technology with CT 64 slice
scanning has better resolution, etc. and provides a detailed cross-sectional view of the walll amount of volume and USTABLE PLAQUE (that is soft plaque).  Furthermore software advances facilites quatification of non-calcified plaque burden.  The new techology is so sensitive that it can detect a fibrous cap (separates lesion from the arterial lumen...usually weak and prone to rupture.......etc, etc.







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976897_tn?1379171202

"I know about about foam cells, etc. that is irrelevent"

It's fully relevant though. A foam cell is soft plaque. It's a macrophage that has been filled with fat using LDL. Why would you not class them as relevant? This is the deadliest form of plaque.

"New technology with CT 64 slice scanning has better resolution "

Well, new/old. We've had the 128 / 256 slice since then and now the 320.

This is from a paper in 2008 regarding trials on the 64 slice....

CONCLUSION: Negative 64-slice CT reliably excluded significant coronary disease. However, the data suggest that stenoses shown on 64-slice CT require confirmation. Combining the results of 64-slice CT with a pre-CT clinical probability assessment would strengthen the diagnosis. Due to the risk of radiation-induced cancer, patients should be selected carefully for this test, and scan protocols should be optimized to minimize risk.



the 256

"CONCLUSION: 256-MDCT could potentially be employed for clinical assessment of stent patency in stents >3.0mm when analysed with cardio-dedicated sharp kernels, although clinical studies corroborating this claim should be performed. However, stents </=3.0mm reconstructed by soft kernels revealed insufficient in-stent lumen visualisation and should not be used in clinical practice. Further improvements in spatial and temporal image resolution as well as reductions of radiation exposure and image noise have to be accomplished for the ambitious goal of characterising both CT coronary artery anatomy and in-stent lumen."
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367994_tn?1304957193
Q: "It's fully relevant though. A foam cell is soft plaque. It's a macrophage that has been filled with fat using LDL. Why would you not class them as relevant? This is the deadliest form of plaque"

>>>>>Your comment relates to the etiology of cells and pathogenesis, I am on the subject of cross sectional nature of CT imaging that enables characterization of coronary lessions according to their attenuation characteristics as calcification, non-calcification or mixed plaque. Also, the composition has dynamic characteristics.

It is true that 64 slice is older technology and a more inherit risk to over exposure.  The point is it has be around for awhile!  Now you are changing the subject and bring in the exposure risk and stents?  We all know the higher end techonolgy has less risk?
I have 2011 technology and CT software that confirms.
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976897_tn?1379171202
">>>>>Your comment relates to the etiology of cells and pathogenesis, I am on the subject of cross sectional nature of CT imaging that enables characterization of coronary lessions according to their attenuation characteristics as calcification, non-calcification or mixed plaque. Also, the composition has dynamic characteristics"

which must include soft plaques/foam cells to form any beneficial usage. It's not just what's in the lumen that is important.

"a buildup of soft deposits embedded deep within the walls of the heart’s arteries, undetectable by angiography or cardiac stress tests – and prone to rupture without warning. "

Where did you copy/paste this from? it's a bit out of date. There are techniques using angioplasty which can see soft plaques. Cleveland clinic has such technology.
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367994_tn?1304957193
You keep changing the subject, and what you say is irrelevant. What part of angioplasty don't you understand?  Lets get some definitions out of the way so you don't get confused. Angiography by definition is procedure using a contrast medium to view the lumen of a vessel for lesions...it is CTA or cath. Angioplasty is a procedure to eliminate areas of stenosis within a vessel.  A cath with ultrasound can have some utility to view the inner walls of a vessel. However, and not surprisingly you have NOW changed the subject indicating soft plaque can be calculated with angioplasty!!! Are you for real? How does the definition for an angioplasty procedure equate to imaging the inner linings of a vessel? Haven't you stated soft plaque can not be viewed, whatever, I tried to help you understand.

I don't cut and paste, my research is on computer files, and gathered from many sources over a period of time...I do keep abreast of new innovations...that's what it is all about.  Every time you are shown to be wrong you get testy, so cool it if you want a discussion, and please try and stay on the subject. When given an answer that is answers your question you change the subject!

Q:" which must include soft plaques/foam cells to form any beneficial usage. It's not just what's in the lumen that is important".

>>>>>Where in the world does that thinking even come into play?? I thought the discussion involved calcium scoring, not angiogram nor angioplasty!  Calcium scoring involves calculating vulnerable plaque within the linings of the vessel  ...the lumen is the hollow part (channel) of the vessel.  I have explained it, and if you don't understand that is not my concern.  

I don't know if you are intentionally trying to annoy, but if you don't have any further information that stays with subject there is no useful purpose to continue, and I don't have the time nor inclination to go back and correlate all your inconsistency on the subject to help you understand. It's becoming boring! Take care  

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976897_tn?1379171202
Right, lets go back to the original remark I made then. Just keep it to that and don't add anything extra. You said, and I quote  "The CT score calculates the amount of soft plaque within the linings of the vessel", if you look up, it's in your first post.
I'm saying this is wrong. If you still believe your comment is correct please supply a reference which shows this to be true because everything I've read states soft plaque is not detected.
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