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Can you advise your thoughts on this result? The patient is male 45, about 80 lbs overweight, doesnt eat healthy, doesn’t exercise, and drinks a lot. Is on blood pressure and cholesterol meds. Dr also has him take a baby aspirin and CoQ10. His echo was normal. Hasn’t done a stress test yet.
PROCEDURE: Noncontrast images were obtained of the heart specifically for
calcium scoring purposes.
COMPARISON:None available
SCORE SUMMARY
The total calcium score is 2.
RANKING GUIDE
The total calcium score of 2 is between the 25th and 50th percentile for
males between the ages of 45 to 49. This means that 25 percent of people
this age and gender had less calcium than was detected in this study.
Left Main Artery (LMA) - zero
Right Coronary Artery (RCA) - 2
Left Anterior Descending (LAD) - zero
Left Circumflex (LCX) - zero
Posterior Descending Artery (PDA) - zero
Total: 2
COMMENTS: There are no significant findings in the visualized extracardiac
mediastinal structures or lung fields.
CALCIUM SCORE:
0-0: No identifiable atherosclerotic plaque. Very low risk.
1-10: Minimal identifiable plaque burden. Low CVD risk.
11-100: Mild plaque burden. Mild or minimal CVD risk.
101-400: Moderate plaque burden. Moderate CVD risk.
Greater than 401: Extensive plaque burden. Very high CVD risk.
------------------------------------------------------------
The CT scan was performed with attention to patient radiation dose
reduction, as low as reasonably achievable (ALARA), while maintaining
diagnostic image quality. At least one of the following dose reduction
techniques was used: Automated exposure control, adjustment of the mA
and/or KV according to patient size or use of iterative reconstruction
technique.
Reason for Exam:->high cholesterol
Is the patient pregnant?->No
What is the patient''s sedation requirement?->No Sedation
Imaging Center - , Reading Radiologist
Accession ID:
Notes:
4/19/2018 9:51:23 AM > minimal plaque seen on ct cardioscan continue asa and atorvastatin ; proceed with stress test when rqi available; check fasting lipids cmp in 4 weeks advised 4/23/2018 1:58:00 PM > lmcb 4/24/2018 3:46:46 PM > pt. notifeid and understands.
Notes:
4/19/2018 9:51:23 AM > minimal plaque seen on ct cardioscan continue asa and atorvastatin ; proceed with stress test when rqi available; check fasting lipids cmp in 4 weeks advised 4/23/2018 1:58:00 PM > lmcb 4/24/2018 3:46:46 PM > pt. notifeid and understands.
The result was minimal plaque seen, which is good.
Right but there is the start of plaque in one artery. How fast can that get worse and can it be reversed. His cholesterol wasn’t that high but his triglycerides were over 500. Also borderline diabetic. A1C was only 6.2 though but dr said to monitor it.
-experience from Viet Nam showed us that even many 19 y/o's have the start of plaque in their arteries
-The story of the "CT Calcium Score" is a classic example of "We've invested a lot of money in this research, let's start recouping it now before the technology is ready. The public and most of the doctors are stupid and won't know it isn't much good yet."
It would be nice if we could just do an x-ray study to see the extent of coronary disease. But the technology available ~10 yrs ago prevented that-- two problems-- Ct scanners weren't fast enough to do "stop action photos" of the heart (you got blurred pictures) and the resolution of the "lens" was too low (two dots very close together looked like one big blurry dot.)
Then they solved the first problem at great expense in investment, but the second problem remains.
Now the pictures they get depend on the presence of calcium in any plaque in the arteries- just like regular x-rays only see bones and not muscles. That's good enough for old guys with plaque for many years, because old plaque eventually does get calcified-- but newer plaque may take years to calcify, so a "good" scan in a younger patient may not mean much.
Likewise, a "bad" scan may not be as bad as it looks because there is only a little plaque but lot of calcium. Summary- fairly high number of false negatives and false positives with these tests.
Anyone with at least two risk factors for coronary disease or symptoms suspicious for artery disease deserves a stress test with nuclear scan. This test pretty accurately separates people into two groups- those who should proceed to coronary angiography and those who don't have to (yet.) The CT Ca Score doesn't really add any more accuracy to making the right diagnosis.
BTW- a point never emphasized is that regular exercise negates the adverse effects of high chol, rendering it meaningless. (ie-- among those who get regular exercise, chol values have zero power of prediction of future heart problems.
Can you advise your thoughts on this result? The patient is male 45, about 80 lbs overweight, doesnt eat healthy, doesn’t exercise, and drinks a lot. Is on blood pressure and cholesterol meds. Dr also has him take a baby aspirin and CoQ10. His echo was normal. Hasn’t done a stress test yet.
So you are saying the CT score test isn’t accurate? My dr said it can pick up things a stress test can’t.
Ask him:
a) Like what?....and
2] This pt had an excellent CT-Ca Score-- is the doctor confident enough in the result to cancel the stress test?
Your doctor ordered the Ct-Ca Score test because that's what the latest MacDonald's Rules for the Practice of Mediocre Medicine written by the lawyers insists is the standard thing to do. I call it the MacDonald's because like the fast food chain, you get the same boring, not-very-good-but-probably-won't-kill-you meal everywhere in the country.
A score of 2 is not that much different from zero. That shows basically no calcification in the arteries. Not really anything to worry about as far as hard plaques go. These scanners have a margin of error and can sometimes invent a few points that might not even be there as well depending on the quality of the machine and how many slices it does.
It's far more accurate than a stress test for detecting hard plaques, but soft plaques may not show up. It's certainly a useful tool. I routinely get a cholesterol reading of 125 with triglycerides of around 40 mg/dl and I had a score of 1.
It's not bad, but remember that not all kinds of heart disease are shown on a CT scan. My Dad had a "great" heart ct scan, and then died of a heart attack less than a year later. At 80 pounds over weight, sedentary, with high blood pressure and cholesterol, and poor diet, I would not describe this patient as "heart healthy." And I don't think most doctors would either.
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