calcified coronary plaque

[incatalk]

A coronary ct scan revealed the following: 1. severe calcified coronary plaque 2. left main is normal 3. Less than 50% proximal LAD stenosis followed by an area at which site significant stenosis cannot be excluded 4. totally occluded D2 5. Non-obstructive LCx disease 6. Normal ejection fraction and chamber size with apical akenesis.

Having a nuclear stress test today.

Question:  Does this condition require a further angiogram test?  Depending on outcome, would it be followed by angioplasty or a by-pass?
Thanks.

[incatalk]

Most pleasantly surprised at the quality and number of responses - all so helpful for which I thank all of you again.  This is a very helpful website. Happy Holidays all.

[kenkeith]

Apparently, the CT scan has detected plaque that is localized under the intima, within the wall of the artery. The rest of the report seems to address occlusions or lesions that narrow (stenosis) within the lumen.

[ed34]

I find it strange how the report starts with the very frightening statement "severe calcified coronary plaque", but then as you read through the rest of the report, there isn't anything severe at all.

[kenkeith]

Thanks for the update, and Happy Holidays to you as well.

[incatalk]

thank you so much for your detailed and very helpful comments.  The stress test confirmed that I needed no further treatment - I have yet to see the details.
Happy Holidays.

[kenkeith]

Hi incatalk,

You are fortunate to have a normal ejection fraction and chamber size with apical akenesis.  Akenesis indicates, an absence, loss, or impairment of the power of heart wall for movement often due to having had a heart attack.  Akendsis  almost always affects the left ventricle pumping ability, but you have a normal ejection fraction (normal is 50% to 70%) and that is the amount of blood pumped with each heartbeat. The apical location doesn't require much heart wall movement so an impairment at that site may not effect the ejectrion fraction to any degree of significance.

The report indicates some occlusions are not severe.  Less than 50% does not exceed the AAC/AHA guidelines for intervention...exception would if medication does not have an effect on symptoms if any.  Other occlusions have not been identified with any degree of confidence so that may be the reason for a stress angiogram?!

A CT scan 64 slice or larger scores calcium deposits with the software associated with the angiogram.  I had a CT angiogram and after a coronary calcium scan, you'll get a calcium score called an Agatston score. The score is based on the amount of calcium found in your coronary arteries and not the lumen (vessel channel).  The significance of this calcium buildup is the high probability of that plaque breaking into the lumen causing a clot.

Or was the test ECG-gated 16-slice CT scan angiogram of the whole chest showing coronary artery occlusion?  It is not clear why there was CT scan angiogram and now stress test angiogram, but the CT scan was not very decisive according to the report..  Usually the CT scan is not used when there are symptoms of heart vessel occlusions, instead a cath.  But now that a CT angiogram has shown occlusions, why would there be another test for occlusions.  It seems plausible the next step would be a cath and possible stent implants based on the CT angiogram?!  The blockage and degree seems to have already been determined by the CT scan!.

If you have symptoms of vessel occlusion that cannot be treated with medication, then there will be angioplasty.  I have a totally occluded LAD for more than 7 years, a 70% occluded ICX, and an RCA stent implant 6 years ago.  I have been successfully treated with medication.  

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

[cindy707]

Personally i think that is totally up to the decisions that you and your doc make.  The great news is that you have a really pro active doc attending to you obviously by the tests that they are running on you and the results that they are getting.  In answer to your question it sounds to me like they got their answers the first round and w. the nuclear test today they will just be confirming the CT scan and from there is where you two will make your decisions.  The great thing about an angio tho is that is can be a one stop shop type of thing where when they are doing the angio they are also able to take corrective measures and no that does not necessarily mean a bypass...that is sort of the extreme there are all sorts of options out there for you other than a bypass and i am sure the doc will go over them with you....just a couple are med treatments, stenting, boring thru the artery to free it up....etc. however for sure you are going to have to change your dietary intake around a little to prevent further build up........my advice is follow the leader with the doc and see what they have to say after all of the tests are concluded....none of us are doctors on this site altho from time to time a doc does pop in.....just dont take this to the extreme of a bypass yet until a doc says that is the only treatment option open to you...your situation is easily remedied.....good luck w. your test today and let us know how it shakes out......