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Coronary CT Angiogram

From Irshad Khan, New Delhi, India

I have taken last week CT Angiogram and its findings are worrisome. The main impressions are:

Calcium score:      18, Soft plaques seen in proximal LAD and D1 segment.

LEFT CORONARY ARTERY

LM   -  Normal

LAD   -  (Prox/Middle/Distal)-  Type -III LAD with normal course. Focal Eccentric non-calcified plaque seen with moderate luminal narrowing.

Diagonals----  
D1    -----   Single large D1 branch seen with normal course. Mid vessel reveal plaquing with moderate luminal narowing.

Obtuse Marginal Branches

OM1   --- Normal
OM 2  ---  Large OM2 artery seen with distal branching. Proximal vessel reveal focal luminal narrowing with approx  60-65 % stenosis.

Please advise me what course of treatment is advisable.
74 Responses
976897 tn?1379171202
You have some blockages that are mild, and some which are moderate, none which are severe. I would assume that you will be treated with medication and you should be advised of risk factors so you can reduce your risk considerably.
Avatar universal
I am just a cardiac patient, butI do not see too much reason to worry.

Depending of your age, those results can be quite normal.

How your cholesterol and BP are?

Also depending on your symptoms, you might require  stents in the OM2, or just treat it with medication or live style changes for the time been. This you have to discuss with your dr.

Meanwhile, enjoy hot Indian food but avoid fat and salt. The capsicum found in chilly and cayenne peppers is vase dilators and the curcuma has good anti-inflammatory properties.

Jesus
367994 tn?1304957193
Q: I have taken last week CT Angiogram and its findings are worrisome. The main impressions are: Calcium score:      18, Soft plaques seen in proximal LAD and D1 segment.

....You had a CT angiogram and included is a separate procedure a calcium score.  The CT angiogram views the channel (lumen) of the vessels for any hard plaque buildup that would cause a narrowing of the vessel for blood flow and if serious could cause symptoms of chest pain, etc. Soft plaque resides between the layers of the vessel

To add what others have said. The CT score is a procedure that views the anatomy of the vessel and looking for any soft plaque that would be observed between layers of the vessel.  Your score represents  "Soft plaques seen in proximal LAD and D1 segment. LAD   -  (Prox/Middle/Distal)-  Type -III LAD with normal course. Focal Eccentric non-calcified plaque seen with moderate luminal narrowing".

Diagonals----  
D1    -----   Single large D1 branch seen with normal course. Mid vessel reveal plaquing with moderate luminal narowing".

.....The soft plaque can cause vessel remodeling...meaning the soft plaque buildup can reduce the lumen diameter without rupturing the inner layer but can bulge the inner layer into the lumen enough to reduce the diameter (positive remodeling of vessel)...if serious the stenosis (reduced diameter) can cause some obstruction of blood flow causing symptoms such as chest pain (angina pectoris).

To reduce soft plaque would be a heart healthy diet that maintains a good cholesterol levels and medication if necessary to keep cholesterol low .  If and when stenosis is above 70%, that may require intervention as that may reduce blood flow enough to cause a problem.

You have a very good calcium score...my score was very high can have a stented RCA artery, totally blocked LAD and a 72% ICX with a total over 1000 score for all 4 major arteries....prognosis is a 20% probability of a heart event within a year.  That prognosis was over 2 years ago and no problems...the CT scan was of no benefit or utility because I already knew and expected a high score...The risk with a high calcium score is that the soft plaque can rupture through the inner layer causing a heart attack.  Your score is very good but there is a beginning of CAD.

Thanks for your question. Take care,

Ken
Avatar universal
Thanks. Your comments gave me lot of relief. I have been having  high Cholesterol which was detected 16 years ago and my triglyceride has remained out of control despite medication and diet/exercise.  The liplid profile became normal only at two occassions during  the last 16 years.

My Dr suggested CT Angio after I had a couple of episodes during very brisk climbing walk and emotional stress. Now after seeing CT he ( as well as the radiologist) told me that CT angio is not very reliable and variation may be +-10-20%.I have been advised to go for catheter angiography. In India, if one goes for this procedure most hospitals/doctors whould ask for stent/s as they make more money.

I am wondering if medication may help for the time being and angiography/plasty could be postponed. I am not sure if by postponing the procedure, how much risk I would be carrying, though I know no one can easily predict.

Any view please. Thanks

In India, i
  
Avatar universal
My comments above speak about my cholesterol history. I do not have classical angina not have had chest pain so far in the past though I did have pressure on chest a couple of times.

My lipid profile taken two weeks ago is as under:
H Cholesterol       184               range   120-240
S. Triglyceride      278                           50-200
VLDL cholesterol   69                            10-40
HDL                      34                              >50
LDL                     111                            60-150

Ratio of Cholesterol by HDL       5.4            <4.5
976897 tn?1379171202
You have to sign a consent form before the procedure, you can simply make in plain to the cardiologist, and write it on the consent form, that this is for investigation only, and in no way is intervention to be used at this time. Once this is written, they wouldn't dare insert stents because you have unquestionably stated you don't want them.
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