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Multislice or Multidetector 64 Slice CT Angiogram

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Have you had a multislice CT angiogram (Cardiac CT) to check for blockages? Did you continue on to a catheterization or was that not necessary? Post your comments or questions about Cardiac CT to this topic.

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Find out more about this topic in our feature, Multislice CT Angiograms.

Current Postings (125):

• Dan in London - The two tests you have had are both considered accurate, but they measure two different things. The MRI stress scan measures blood flow to the left ventricle, as you've described. And, in your case, there was a perfusion defect seen. This is called a functional test. It doesn't identify the blockage itself, but shows there is a reduced blood flow. The CT Angiogram is a picture of the actual coronary arteries and allows the cardiologist to see if there is a significant narrowing and precisely where it is. This is similar measure to an invasive angiogram, which is done in the cath lab. The CT Angiogram is slightly less accurate but completely non-invasive. Most studies have shown 99% negative predictability, meaning that if the CT shows no disease, you can be 99% sure there is none. The question of why the two tests are at odds with each other is something your cardiologist needs to answer. There may be reasons for the perfusion deficit (prior MI, etc.), other than a coronary narrowing (stenosis).
Angioplasty.Org Staff, Angioplasty.Org, July 8, 2013

• Advice please. I had a cardio MRI stress scan which showed a discreet mid perfusion abnormality which translated means reduced blood flow to the left ventricle. I was later sent for a CT angiogram which showed no heart defects and zero Calcium. Can a professional advise which scan is more likely to be accurate, the cardio stress MRI or the CT angiogram, as I am now quite confused.
Dan, London, United Kingdom, July 7, 2013

• Jon in UK -- The score you are describing is a Coronary Artery Calcium (CAC) score. A high CAC score is not the same as measuring a blocked artery (with an angiogram, either CT or invasive). That being said, CAC has been shown to be predictive of cardiovascular risk. Although this issue has been the subject of much debate within the cardiology community, with a number of physicians feeling that the CAC score may lead to unnecessary concern and further testing in asymptomatic patients, CAC has gained a Class IIa recommendation in the U.S. Guidelines. As we are sure your cardiologist has told you, the best way forward is to reduce your modifiable risk factors as much as possible (diet, exercise, smoking cessation, medications) as it seems you are doing. If you have no symptoms, the guidelines don't indicate further testing, but you should discuss this issue with your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, February 27, 2013

• Hi, 6 years ago I had a CT scan giving a score of 95. My doctor put me on 80mg statin. I am now 49, slim and walk 2.2 miles everyday. My BP is fine (tablets). Last week I had a follow up scan and despite the high statin dose and a (mainly) Mediterranean diet my score has increased to 527!!! Can you suggest anything to keep the score down?
Jon, Cheshire, United Kingdom, February 26, 2013

• Wally in Canada -- A CT Angiogram also uses contrast dye, although less than a standard angiogram. A CT Angiogram could certainly give the surgeon the information he needs for bypass surgery. In fact CT has become an important tool in the field of valve replacement. It probably would give the surgeon more information than the standard invasive angiogram. However...there may be a question as to whether or not you need surgery, or whether an angioplasty/stent could solve your problem. If this were the case, it would only take an extra 20-30 minutes (maybe less) beyond the diagnostic angiogram to fix the blockage. There are protocols regarding hydration, pre-treatment, etc. for patients with impaired renal function. But again, we can't give you medical advice regarding your specific case and we would most definitely defer to the judgement of your cardiologist who is the best source of information to help you with this decision.
Angioplasty.Org Staff, Angioplasty.Org, November 7, 2012

• I have just been advised by my cardiologist, from non-invasive tests, that I have a need for bypass surgery. He says that I require an angiogram. The problem is that I have only one kidney with 15% function. The dye used in the angiogram would substantially reduce my kidney function and require me to commence dialysis. Since I have been able to maintain a 15% kidney function for the past 2 years I am loath to agree to an angiogram. Would Multidetector row slice computed tomography (+64) be able to provide the doctor with the information he need for surgery. Your reply will be very helpful in making my decision. Many Thanks.
Wally, Peterborough, Ontario, Canada, November 4, 2012

• Worried mom in Egypt -- read over this page from the Radiological Society of North America, titled "Can medical imaging exams hurt the baby of a pregnant woman?" As for the dye, it may depend on which brand of dye. Consult your cardiologist and obstetrician to be sure.
Angioplasty.Org Staff, Angioplasty.Org, September 29, 2012

• Hi, if am pregnant is it safe to be injected with the dye? And still undergo the whole process?
Worried mom to be, Egypt, September 24, 2012

• Docvader in Las Vegas -- there can be variations in machines, and also in who interprets the scans. One study found that slice thickness was an important variation (the smaller the slice thickness, the more accurate the score). Other studies have also shown that Calcium Scores can be computed directly from the 256 scans. Not sure how yours was done.
Angioplasty.Org Staff, Angioplasty.Org, September 19, 2012

• is there a difference between 256 slice scanners and the older 64 slice scanners with respect to calcium scores? six years ago I had a calcium score of zero with a 64 slice scanner, now its 90 using a 256 slice scanner. with the increased number of slices, do you see more defects with the newer machines, thus yielding higher scores?
docvader, Las Vegas, Nevada, USA, September 16, 2012

• CM in New Jersey -- An invasive angiogram is considered the gold standard of imaging for coronary arteries. When studies of CT angiograms are done, they are always compared to invasive angiograms to assess their accuracy. So the short answer is that a standard angiogram should be able to image any problem. Not sure what a CT angiogram could show that the invasive angiogram wouldn't, unless your doctor is concerned that there may have been some type of progression. If no blockages were found on the angiogram, then you may have just gotten a false positive for the nuclear stress test (this is NOT uncommon). Nothing here should trump your doctor's advice; however this might give you some specific questions for your doctor. Both the CT angiogram and nuclear stress test involve radiation (the CT scan significantly less, if it's done with a low dose protocol).
Angioplasty.Org Staff, Angioplasty.Org, September 15, 2012

• I had a very bad stress test, my Cardio Dr. Ordered an angiogram believing I had blockage. No blockage at all, my blood work is good, heart x ray good,Echo was good, I wore an event monitor for 2 weeks that was normal. I only feel a chest tightness on occasion. I am a 60 year old female in ok shape, I walk 3x week. Now my Dr. Would like me to have a 64 slice heart scan. Will this give us more info than angiogram? It is costly & am worried about radiation levels. What do you think about doing another stress test, I have asked but no response. Thank you for your opinion.
Cm, Brielle, New Jersey, USA, September 12, 2012

• I am 52 male, i have 3 stents since July 2008, one is drug eluting, I suffered very light ischemia. I had 2 gamma camera test (the last one in 2010), both showed I was very right. My cardiologist indicated me now to do another (I am asymptomatic). 4 months ago i did an echo-Doppler study and was OK (EF 62%). My cholesterol is good, LDL 105, HDL 60, TRIGLIC. 80. (i am with rosuvastatin, and carvedilol). What is your opinion about indicate another nuclear test if everything is OK. I prefer a CAT angiogram that is less radioactive to check for plaques but my cardiologist refuse it. Thanks in advance for your advice.
Marcos, Buenos Aires, Argentina, June 14, 2012

• Worried Dad in Portugal -- Don't see anything that would negate having the CT, if there is concern about a coronary blockage. We're assuming, of course, that you have some type of symptoms, chest pain, etc. Make sure that the place you get the CT understands about low dose protocols (significantly reduced radiation). As Dr. Michael Poon told Angioplasty.Org, you need to ask the center doing the scan, "'What method are you using to lower the dose?' And if they don't know what you're talking about, I would say, 'See you later!'"
Angioplasty.Org Staff, Angioplasty.Org, April 30, 2012

• Hi, Can you help. I am a 53 year old male. I have had a check up for chest pain and have been advised to have CT heart scan. My ECG and echocardiogram appeared OK. My EDV is 63.1 mL, MY ESV is 17.0 mL AND SV 46.1 mL. EF is 73.06%. I have pectus carinatum and type 2 diabetes and depuytrens contracture. Should I go for the CT scan?
WORRIED DAD, Portugal, April 22, 2012

• Kelly in Virginia -- We certainly are not in the position of countering anything your doctor feels is correct. We're curious, however, if you have any symptoms, pain, breathelessness, angina, etc. that might warrant this invasive test. Read our recent article (a press report from the American College of Cardiology) about testing. You do have several risk factors -- but your question about getting a less invasive test (like a CT Angiogram) is one you need to ask your doctor. We support shared decision-making between physician and patient, so that the risks and benefits of any given procedure or test are clear to all involved.
Angioplasty.Org Staff, Angioplasty.Org, April 14, 2012

• I am 49 overweight, prediabetic, take BP meds and a statin. My father died of Sudden death at age 48 (30 years ago) lipids all good, passed several nuclear stress test in the pass, took one on 4/06 felt fine, no pain but doc says "maybe" blockage, being a woman breast tissue can give false positive?? Well he sat there and finally decided on a heart cath which is scheduled for 04/16. I am scared out of my mind of this heart cath..why do u think he didn't suggest the 64 slice? He has been gone so cannot contact till the morning of cath...I feel fine!!!!
Kelly, Spotsylvania, Virginia, USA, April 14, 2012

• Stephen -- Ideally you should have your GP talk with the cardiologist about the need for you to take a statin. There has been much discussion about the issue of prescribing statins for low risk individuals. Whether or not you fit into that category is something to discuss with your doctors. FYI, this opinion piece was recently published in Forbes by renown Yale cardiologist Harlan Krumholtz. It is titled "Five Things You Need To Know When Deciding On A Cholesterol-Lowering Drug."
Angioplasty.Org Staff, Angioplasty.Org, March 30, 2012

• Thank you for that. The specialist called me last night as i was unsure of the explanation of the results. He has advised that the results were good and do not show anything of concern but in light of the plaque he recommends an aspirin daily and cholesterol lowering medication. I an just a little concerned at this as my cholesterol is well within given tolerances. Is this unnecessary at this stage. I am 48, non smoker, regular exercise and have a pretty fat and sugar restricted diet. My own GP actually commented on my recent cholesterol and blood pressure results as excellent. I just find Drs give out medication so freely.
Stephen, New Zealand, March 19, 2012

• Stephen -- There are two types of tests to determine the severity of coronary artery disease, functional and visual. Invasive angiography and CT angiograms are visual: they show a picture of the artery with blockage. From these pictures, a cardiologist can say "this artery is 60% blocked," etc. The other type of measure is functional: is the artery ischemic, does it block enough blood flow so as to deprive the heart muscle of oxygen. A nuclear stress test is such a test. A more accurate test, called Fractional Flow Reserve (FFR), can be done in conjunction with an invasive angiogram. The FAME study showed that even if the blockage is measured at 70%, FFR may show that the blockage can be non-significant, and therefore does not need a stent, etc. So the question you asked is hard to say -- although the indication that "in absence of risk factors this is not thought significant" is certainly a positive point. Read over the above links and the articles in our "Imaging and Diagnosis Center" so you can ask your specialist the right questions.
Angioplasty.Org Staff, Angioplasty.Org, March 18, 2012

• Had a CT coronary angiogram and the conclusion read.1. Low volume three-vessel coronary artery disease, calcified plaques LCx and LAD, calcified and non-calcified plaque in the RCA.2. Non-specific 4mm right middle lobe pulmonary nodule. Clinical correlation required. In absence of risk factors this is not thought significant. Can anyone explain these results as can't see specialist for 2 weeks and am a little concerned.
Stephen, New Zealand, March 18, 2012

• Usman4575 in Pakistan -- You have posted to a topic about CT angiograms. Have you had one? You clearly have the family history risk factor, so it's very important for you and your brother to lower whatever risk factors are under your control. These are, as you mentioned, weight, diet, exercise. no smoking, and control of high blood pressure, cholesterol, lipids, etc. You should consult a cardiologist and get a work-up, so you know your various levels and see if any primary medical therapy is warranted -- and that would include aspirin. As for testing, read over our "Patient Guide to Heart Tests" to learn about what they measure.
Angioplasty.Org Staff, Angioplasty.Org, March 18, 2012

• My father and my aunt (father's sis) died at the age of 54 due to Myocardial Infarction. My father's ECG showed triple vessel involvement. He had no diabetes, hypertension, nor was he smoker or over weight. He used to have active life style. I am now 39 and my elder brother is 42, how much risk do we carry for cardiovascular disease, and should we start with low dose aspirin now? What else should we be doing or monitoring over next years?
usman4575, Pakistan, March 18, 2012

• Had ultrasound on neck and then CT scan on throat and chest this morning. Still waiting for a call with results. How long does it take to get results!? Can't climb stairs without feeling shortness of breath and dizzy. Chest feels bruised. Also have polycythemia vera.
KPfromWI, Rice Lake, Wisconsin, USA, March 2, 2012

• Rob -- read over the interviews and articles in our Diagnosis and Imaging Section for more info on CT Angiograms. Costs can vary considerably from facility to facility. You should definitely make sure go to place that has the latest equipment and practices low-dose protocol, because if not done with low-dose, the radiation from a CT is more than from an invasive angiogram. But you're caught in a controversy, which is that asymptomatic patients, especially those who have negative findings on stress tests, are not usually considered appropriate patients for a CT Angiogram, since there is no reason to thik there is any disease. That being said, it's a decision between you and your doctor. Read our articles and also you might want to consult the cardiac imaging departments at Cedars-Sinai or Harbor-UCLA, both of which are excellent resources.
Angioplasty.Org Staff, Angioplasty.Org, March 1, 2012

• I am 35yo male with family history of heart disease. My father had a triple bypass when he was 40. I have high cholesterol numbers and have had EKG and stress tests that show nothing abnormal. How can I get my doctor to refer me to get a 64 slice CT Scan and what costs have people seen associated with this test?
Rob, Huntington Beach, California, USA, February 29, 2012

• Joehand1 -- Check out our topic on Calcium scores. The CAC score is a surrogate marker. A high score has been shown in some studies to correlate to an increased risk of coronary artery disease (CAD). Your score is certainly high -- whether or not you are at risk for CAD, given your lack of symptoms, negative thallium stress tests and high activity level, is unclear. The only way to know for sure would be to do an angiogram, and that's not indicated since you are basically asymptomatic. (BTW, a CT angiogram, very different from a Calcium score, might not be that useful, since the high calcium score usually means the CT will not be "clear" since calcium blocks CT imaging.)
Angioplasty.Org Staff, Angioplasty.Org, February 26, 2012

• I am a very fit 54 yr old asymptomatic doctor. I had a test run of our CT 5 yrs ago and was surprised to find a CAC of 184. I have been on Zocor and niacin for 5 yrs, worked out and kept my LDL in the 70 range and HDL in the 60 range. I underwent another CAC last week and my score went to 584. I did a thallium stress test to the full 10 minutes on the treadmill without any changes. I ran 4 miles yesterday AFTER a workout, and ran the last mile in 8 minutes....Does this exercise give me any measure of protection?
Joehand1, USA, February 25, 2012

• Manus in Florida -- Your cardiologist should be able to recommend the best diagnostic option for a CT Angiogram. You want to be sure to go somewhere that specializes in Cardiac CT, somewhere that uses the very latest equipment (that would be 64 slice or higher -- the latest ones are 256 or 320) and one that practices "low dose protocols". CT exposes the patient to radiation (so does a nuclear stress test) so you want to be sure to use as little as possible. But CT scanners for use in the heart have gotten much better in recent years in terms of resolution, etc. And the newest CT units are very fast!
Angioplasty.Org Staff, Angioplasty.Org, October 23, 20121

• I had an x-ray that showed abnormal results. I also had nuclear stress test which showed no problems. The Cardiologist said there is not a heart problem. The Internist said to get a CT scan with contrast. The Cardio concurred, but said the issue is not a heart issue. I have seen several types of CT scans advertised in my area: multi slice, 16 slice, 32 slice, and 64 slice (as well as ones that just say CT scan). Which one is best? Is 64 better than 16? Are they all as fast (I have some claustrophobia concerns about the CT machine). Thanks :)
Manus, Tampa, Florida, USA, October 19, 2011

• I have severe allergy to iodine containing dye and need a coronary angiogram. My body becomes swollen.What are my options?
shiela naidoo, Durban, South Africa, September 29, 2011

• S Himmatramka in Kanpur -- CT angiograms are very accurate for "negative predictability". In other words, if you have no or little coronary artery disease, it shows that. Things get a bit more complicated, and less accurate, when trying to assess exactly what the extent of the narrowing is. Given that the measurements you got were estimated at 40-50% -- most cardiologists would consider those not particularly great, assuming they are accurate. The bigger question would be if those blockages are causing "ischemia" -- or lack of blood flow and oxygen to the heart muscle. This blood flow, called "perfusion", is not something that can be measured yet with a CT scan, although work is ongoing and it probably won't be long before that happens. Right now, the best non-invasive test for perfusion is a nuclear stress test, which shows the uptake of oxygen. Are you experiencing chest pain or angina? Not sure what "giddiness" would be caused by. We cannot give out medical advice, so we would certainly recommend that you consult a cardiologist with your results. Bypass surgery in somone your age with 40-50% blockages is probably not what most would consider the next step. Certainly you first would want a stress test and invasive angiogram (possible angioplasty -- IF the blockage was significant -- and that is an "IF".
Angioplasty.Org Staff, Angioplasty.Org, September 25, 2011

• I am 76 years old man. I am having this persistent giddiness continually.So I decided to undergo an angiography and here is what my report says:My MDCT coronary Angiography shows the following results:Proximal LAD shows fibrocalcified plaques causing 40%-50% narrowing. Another calcified plaque causing 50% narrowing. Proximal RCA shows multiple small soft plaque causing 20%,30% narrowing and small calcified plaque causing 45% ,50% narrowing respectively,distal to it RCA,PDA,PLV shows satisfactory pacification. Proximal ramus intermedius shows calcified plaque causing 50% to 60% narrowing ,distal to it shows satisfactory opacificatio. I had consulted 2 doctors and got 2 different suggestions from them .One told me immediately stop all physical actively immediately and go for a bypass whereas the other one said that all is fine and continue to work as usual. I am quite confused about it.Is it related in someway to my blockage in the arteries?Please Help Me.
S Himmatramka, Kanpur, India, September 25, 2011

• Johng in UK -- The Vitrea is made by Vital Images (more info here on the Vitrea Viewer) but exactly what this comment means is hard to say from afar. The Vitrea is a well-established and robust DICOMM viewer used in this field, but there can sometimes be software issues between the scanner, viewer, etc. We would certainly press the cardiologist who ordered the test to find out what this comment means. However, a single phase study is not necessarily inaccurate. Single phase studies, like "step and shoot" methods offer a way of reducing radiation dose while maintaining accuracy for interpretation. Hope this helps.
Angioplasty.Org Staff, Angioplasty.Org, September 24, 2011

• I have recently acquired a copy of my imaging report for a recently carried out CT Angiography scan on a 64 slice scanner.The following sentence was listed under the comments section of the report by the scan imaging consultant: "This report is based on the assessment of a single phase on the Vitrea study viewer as I was unable to load the study in the Vitrea viewer for formal assessment" What does this mean? does it suggest that a full multi dimensional scan has not been viewed or that a sub standard analysis has been made. Any answers would be appreciated as I am concerned that the report given could be inaccurate or misleading.
johng, Edinburgh, United Kingdom, September 19, 2011

• Dear Sir, 2 years ago i had admitted to National heart foundation for my heart attack after 6 days doctors said that need to you ANGIOGRAM but i did not angiogram till date.Now i want to check my heart block by CT CORONARY ANGIOGRAM so can possible like ANGIOGRAM ? Please help me and response me.Best regards
Mahabub, Dhaka,Bangladesh, August 2, 2011

• Pat in San Diego -- we have a topic on "Myocardial Bridging" and there seems to be a wide spectrum of opinion about treatment. Check it out; you might want to ask a question there.
Angioplasty.Org Staff, Angioplasty.Org, April 23, 2011

• After a Nuclear Stress Test showed areas appearing to be blocked, I had a CT Cardiology Angiogram. The results showed no blockages, but a "bridging" of some arteries. My cardiologist said it is rare -- about 1% of population has bridging. Should this be followed up?
Pat, San Diego, California, USA, April 22, 2011

• Meenakshi in India -- Most people are either right or left side dominant regarding their coronary circulation. In your case it means that your Right Coronary Artery (RCA) is the "workhorse" delivering blood and oxygen to the heart muscle, which is the case in most people.
Angioplasty.Org Staff, Angioplasty.Org, April 2, 2011

• in my ct angiography report, it is return that right sided dominant circulation, what does it mean please explain.
Meenakshi, Samved Hospital, India, April 2, 2011

• Jesus in Lake Elsinore -- Total body scans can be useful in certain circumstances (see more on total body scans from the Cleveland Clinic), although they are not targeted specifically for the heart. A different type of CT scan is the CT Angiogram (CTA) which we discuss in our Imaging and Diagnosis Center. It has been shown to have a high degree of "negative predictibility" -- if the CT shows no coronary disease, then it's 99% correct. If it shows disease, then it's a bit less definitive, but still valuable information. We're not sure exactly the type of full body scan you got -- it may or may not be as accurate in diagnosing a blockage as a CTA. In any case, even though 77% sounds like a hard solid figure, there are many variables in such a measurement, even with the so-called "gold standard" diagnostic test: the invasive angiogram, done in the cath lab. The question is whether or not the blockage is significantly impeding the delivery of oxygen to the heart. And sometimes a blockage that looks significant to the eye in reality is not really causing a problem. In our article from last summer, "To Stent or Not To Stent: Fractional Flow Reserve (FFR) Trumps Angiography in Diagnosing Blockages up to 90%", 2 out of 3 blockages in the 50-70% range were not causing poor blood flow or oxygen loss to the heart. Even in the 71-90% range, 1 in 5 were not problematic and did not need to be stented. FFR, of course, is only done during an angiogram in the cath lab. A non-invasive stress perfusion test might show if there is an oxygen deficit in your LAD, in which case, you might be advised to continue on to the cath lab for an angiogram and possible angioplasty/stent. The fact that you are not having symptoms is certainly a good sign and probably one that should ease your worries about an "emergency". But certainly you have something going on there, so modifying any risk factors under your control is wise: stop smoking if you do, take prescribed meds, watch your diet, etc. And let us know what your tests show.
Angioplasty.Org Staff, Angioplasty.Org, March 23, 2011

• I had a total body scan and was told that have 77% blockage in LAD. Consulted my cardiologist and was told to take Aspirin and increase my statin. Said she will order Stress Test and Echocardiogram and still waiting for test to be done. She said I don't have symptoms right now so don't worry, it might just be start of something. Is she right that my blockage is not an emergency? I'm so worried, HELP!
Jesus, Lake Elsinore, California, USA, March 23, 2011

• Rose from Australia -- We're just curious as to why you had a CT Angiogram in the first place. Were you having symptoms or did you have an abnormal stress test? In any case, we cannot give medical advice, and we certainly do not aim to be a substitute for medical advice from your doctor. But we can state that studies have shown CT angiograms to be 98-99% accurate for negative predictability. In other words, if the CT shows no coronary disease, you can believe it. However, CTs are not quite as accurate when showing if disease exists, which is your situation. So an invasive angiogram would probably be more accurate. But even if an invasive angiogram shows a narrowing, whether or not to stent that narrowing is a decision that can be very complex, especially in the absence of symptoms. Read our overview on Fractional Flow Reserve (FFR) and you'll see that not every "narrowing" that can be seen on an angiogram needs to be stented; this is known as the oculo-stenotic reflex: "if you see a narrowing (stenosis) then you must stent it". The FAME study showed that 1/3 of stents placed by using the angiogram as a guide were not necessary when using FFR as a guide -- and the outcomes of patients were 1/3 better in the FFR group. In other words, unnecessary stenting can actually make for worse outcomes. This being said, your cardiologist really has the most complete and accurate information about you. We urge you to discuss your options with him/her. Is there some emergency situation impending?
Angioplasty.Org Staff, Angioplasty.Org, February 20, 2011

• I am a 64 year old woman who has had high cholesterol for 20 years. I am fit - do regular long walks and tend a large garden - and have no other health problems. I don't suffer from any chest pain and I'm never short of breath. I have a very good low-fat diet and do not eat red meat. I cannot take statins as I have had a bad reaction to them. . I was recently scanned with an Aquilion 1 320 slice CT scanner and it showed:LAD & DIAGONALS LAD: Eccentric calcific plaque near the origin of the D1 with luminal stenosis of less than 50%.Ramus: A small vessel which is normal.D1: A large vessel which is normal. LCX & MARGINALSLCX: A non-dominant vessel with soft plaque of more than 70% luminal stenosis distal to the OM2 origin.OM1: No diseaseOM2: No disease RCA& Branches: /H/RCA: A dominant vessel which terminates in a PDA branch. There was no significant disease. My cardiologist says that I need an angiogram and a stent. Do you think this is necessary? I would like to avoid having an invasive angiogram and a stent.
Rose, Australia, February 20, 2011

• Kaicy in India -- Are you having symptoms or is there any reason why you are concerned? Every "look-see" with either standard angiography or a cardiac CT involves additional exposure to low-dose iozining radiation. Although levels have gotten very low with newer equipment and protocols, these imaging procedures are not indicated unless there is a specific reason or symptom.
Angioplasty.Org Staff, Angioplasty.Org, February3, 2011

• i have undergone angioplasty 10 months back. a single drug eluting stent was positioned in LAD. how to determine if things are in order? another coronary angiogram or a CT angiogram?
kaicy, India, January 21, 2011

• Wonderful advice! I so appreciate your help, and I will look into these doctors. The dr with that "bedside manner" happens to be at one of those NYC hospitals you mentioned (which I will not reveal), but thankfully is not one of the dr's you referred me to! I will certainly contact them and keep you posted. And everyone, please consider donating to this site, it is a wealth of information and comfort. Where else can you get such great information AND expedited? My dr's don't return phone calls as quickly as I've gotten responses here! Good luck to all and many thanks to the forum editors!
Denise, Connecticut, USA, December 5, 2010

• Denise in Connecticut -- Your doctor said, "Do what I say or die?" -- Wow. We really can't add to your comment re: "bedside manner." In any case, you have a problem that is not uncommon, although for somewhat different reasons. People who need renal angioplasty, who are suffering from high blood pressure, pulmonary and other problems due to reduced kidney function, are also highly susceptible to the negative effects of contrast dye -- since contrast burdens the kidneys, so you don't want to worsen the problem by "looking at it". As previously mentioned, there are protocols, such as hydrating the patient, diluting the contrast, using different types of contrast, that are used. You have a different problem: an allergy. But the idea is still to use as little contrast as possible. It sounds like you've discussed your case with several physicians. Perhaps check out vascular centers in NYC -- not that far from Connecticut. Lenox Hill, Columbia-NY Hospital, Mt. Sinai, NYU all have large volume practices in interventional cardiology and radiology. Also, if angioplasty is decided upon, see if the physician uses the transradial approach (from the wrist) -- Dr. John Coppola (now at NYU) told us that he feels the wrist approach makes renal angioplasty easier (and it's better for the patient). Drs. Garratt and Cohen at Lenox Hill also use the radial approach extensively. Good luck and let us know how things progress.
Angioplasty.Org Staff, Angioplasty.Org, December 5, 2010

• Thank you for your kind response of 12/4/10. I did have an MRA w/gadolinium, but the results were inconclusive due to poor imaging despite it being a new machine. Drs who tried to read it in other hospitals concurred. There seems to be severe tortuosity and turbulence within the proximal to mid vessel of the left renal. One dr said to just treat with bp meds, but I had a paradoxical reaction to several classes (raising my bp to 250/135 from the high of 158/98 or more). I am currently on xanax .25mg 2x/day which keeps it between 120-140/70-90 depending on diet, etc. The other dr said anything can be angioplastied even if it is looped (which it is), and he wanted me to take 40mg pred 3x before procedure with 50mg benadryl with no guarantees I still wouldn't react to the contrast dye. I am hypersensitive to it since I can sleep for days on end with just 12.5mg. I explained this & was just told "do you want to die then?" Horrible bedside manner. I am also sensitive to 20mg pred with heart fluttering, rash, and what feels like a swollen head. I'm beside myself as I have back pain that goes into the spleen when my bp rises. There must be some recourse, but I don't know what that is.
Denise, Connecticut, USA, December 4, 2010

• Denise in Connecticut -- has your doctor mention an MRA? It may be possible to use this with no or very diluted contrast. If you have a blockage which needs opening via balloon and/or stent, some contrast will have to be used -- but there are protocols for dealing with patients who have hypersensitivities to contrast dye.
Angioplasty.Org Staff, Angioplasty.Org, December 4, 2010

• Pattie in San Diego -- Sorry for the delay in responding. Your doctor is sort of correct. There are some advanced systems and techniques that can image patients with stents. Here is an example of a protocol posted by Dr. Stephan Achenbach. In our exclusive interview with Dr. Achenbach, he discusses trying to measure in-stent restenosis using CTA -- and he says it's definitely not a routine clinical indication at this point. However, "this point" was in 2007 when we interviewed him, and equipment has advanced since then. We recently saw a scanner, for example, demonstrated by GE that visualized the flow through a stent. But for this purpose, these tests are not yet as accurate as the testing you might have via an invasive angiogram. We assume you are concerned about whether the stents are still open or "patent". A nuclear stress test can tell if there is any ischemia in the parts of the heart supplied by those stented arteries. But if you are having symptoms, and have some ischemia, then the standard angiogram is the only sure imaging method, especially if they use IVUS or FFR to measure the internal diameter or pressure through the stent. So your cardiologist might recommend an invasive angiogram if there is a high likelihood that the stents are partially blocked. An advantage is that the stents can then be reopened in the same procedure.
Angioplasty.Org Staff, Angioplasty.Org, December 4, 2010

• I have been diagnosed with renal artery stenosis (80%) in my left renal artery via renal doppler u/s. There is a possibility the narrowing in my right renal & right carotid are fibromuscular dysplasia. I am allergic to the contrast dye so I have not done the CTA. I had a 64slice cat scan of the heart with 0 calcium score (no dye). Does this mean I can eliminate blocked coronary arteries? Some say if the renal is blocked most likely so are the coronary arteries. Is there a 64 slice that could look at the renal arteries perhaps (that would not use dye and give an accurate view).
Denise, Connecticut, USA, November 16, 2010

• I heard from my Dr. that they can not perform a 64-slice CT scan on me because I already have 2 stents. Is that correct? She said they scan would not be able to see in the stented area. Any experience with this would be greatly appreciated.
Pattie, San Diego, California, USA, November 3, 2010

• What significance does low blood pressure in one arm have? I have already had a ct angiogram?
Melliot, Scotland, United Kingdom, September 28, 2010

• Sheila -- if the emergency room CT was done correctly, it would have shown coronary blockages. The CTA has a 98-99% negative accuracy, meaning that if the CTA shown no disease, there is very little chance that there is any. Nuclear stress tests have much higher rates of false positives.
Angioplasty.Org Staff, Angioplasty.Org, July 6, 2010

• I'm a 49 year old female, overweight with hi cholesterol. I don't know my family history, I'm adopted. I went to the emergency room with chest pain, they did a CT scan (don't know what type) and said everything looked normal. My primary care sent me for a nuclear stress test and is also testing for gall bladder and ulcer, no results back yet. Stress test results said there might be a blockage and they want me to do a catheterization. Is the catheterization necessary if the CT scan is normal? I'd rather not do the catheterization unless it's really necessary.
Sheila, Maryland, June 28, 2010

• Hi my name is Gina and i really need your help, i had a cardiac CT scan with contrast 3 years ago which showed no blockage i am 33 yrs old but my family history is very strong for CAD and heart attacks very young, My feeling is with my family history should i be concerned i have blockage now??how long does it take for blockage to build up i am a little overweight have semi high cholesterol (206) my blood pressure is 110/60 and i eat pretty well and quit smoking 3 years ago but everyday i am scared I'm gonna have a heart attack its crazy my brother was 29 when he died and I'm just so scared I'm gonna end up like him...Please help!!!
Gina, Myrtle Beach, South Carolina, USA, June 25, 2010

• A stress echocardiogram indicates that I have a blockage. The cardiologist wants me to have a CTA. I have asthma/COPD. Per my internist I cannot take beta blockers and years ago had trouble with ACE inhibitors. I take an ARB for my hypertension. Will I be able to have a CTA with a 64 slice unit without pre-medication to slow my heart rate down?
Delco, Delaware County, Pennsylvania, USA, June 15, 2010

• Sanju -- unfortunately, CT Angiograms also use contrast dye, although a bit less than a standard invasive angiogram. But you should discuss your allergy with the cardiologist who will be doing the invasive angiogram -- there are techniques to lessen reactions, special contrast dyes that use less or no iodine and hydration protocols -- tests may need to be performed to judge exactly what in the dye causes the hypersensitivity reaction -- it may not be iodine.
Angioplasty.Org Staff, Angioplasty.Org, April 24, 2010

• I have severe allergy to iodine containing dye and need a coronary angiogram. What are my options?
Sanju, Encinitas, California, USA, April 24, 2010

• Patrick -- Nuclear stress tests (done with a technetium isotope, a.k.a. Cardiolite) carry a not insignificant amount of radiation exposure -- about 14-15 millisieverts -- so an annual nuclear stress test is exposing you to more radiation. A CT Angiogram, if done with up-to-date equipment and dose reduction protocols, can be done as low as 2-7 millisieverts and can accurately rule out coronary blockages. As for an invasive angiogram, that might be called for, if an intervention is being considered. We assume you've already had an invasive angiogram in the past, which is how you know your LAD stents are blocked. Have you had an interventional cardiologist (the doctors who perform stenting) look at that angiogram? A blocked stent CAN be reopened (with a balloon or sometimes another stent is placed inside) -- you might want to have an interventionist who specializes in total occlusions take a look. And check out our Forum Topic on "InStent Restenosis".
Angioplasty.Org Staff, Angioplasty.Org, April 23, 2010

• I have a history of heart disease in the family, and have had hypertension for years. I am 50 yrs of age, I have three stents in my arteries, two in the LAD which have completely reblocked, and one in the RCA which apparently is critical to my survival. I've had to be aggressive with my cardiologist to get a Nuclear Stress Test, which they call cardio-lite, every year. Apparently, my heart has grown collateral arteries to get around the blockage in the LAD. Should I be pushing for a CT slice angiogram, or even an invasive procedure? My understanding is that if that RCA blocks up like the other stents did, I won't survive the heart attack.
Patrick, Orange, California, USA, April 14, 2010

• Cheryl -- the choices for tests would be (1) a nuclear stress test (e.g. Cardiolite), (2) a CT angiogram (a more extensive CT test than the Calcium scoring) or (3) a standard invasive angiogram (arteriogram) which takes place in the cath lab. There is much debate over whether option 1 or 2 is the best. The CT angiogram is more accurate, some feel, in intermediate patients -- it actually shows an image of the heart and arteries -- and can safely rule out if there are any blockages. The nuclear stress test can't really do that as accurately, but it does show other info. Read more about all these tests in our Patient Guide to Heart Tests.
Angioplasty.Org Staff, Angioplasty.Org, March 25, 2010

• I'm 51 white female with a history of high blood pressure and a family history of heart disease just had a ct calcium scan my score was 184.5 was told that I'm in the moderate calcification I'm really unsure as to what this means . i have been having some chest discomfort and pain and back tightness in jaw , but it comes and goes, mostly when my b/p is up can you give me some help on what my next step should be. my dr. wanted me to have a arteriogram done but decided on the ct scan instead.
Cheryl, Rossville ,Georgia, USA, March 16, 2010

• i had a 64 slice ct scan and continued on to cardio cath
Dan Grifo, Valrico, Florida, USA, March 3, 2010

• Thank you for your response. I went ahead with the CT scan and it has been some of the best money I have ever spent. The test showed minimal amounts of calcium deposits, with no need for invasive treatment. My regular cardiologist agreed that the stress test was a false positive. Man am I a happy camper!!
Ken Wright, Fullerton, California, USA, February 17, 2010

• Kelly -- A CT Angiogram can reveal if there are blockages in the coronary arteries. If it shows none, then it's 99% accurate that there is no coronary artery disease. The test is noninvasive but does use radiation and some contrast dye (same kind used in an invasive angiogram). If a CT is going to be done, make sure the physicians are using low-radiation dose protocols. Read our articles about this issue in the Imaging and Diagnosis Center.
Angioplasty.Org Staff, Angioplasty.Org, February 2, 2010

• My husband is on a business trip in the Philippines and is having chest pains. Hospital did EKG and blood tests and all came back normal. Felt better after taking something for GERD. Doctor now wants to do a CT angiogram. We're wondering if it is necessary to expose to radiation when other tests came back OK and he is feeling better? He is also worried about blood clots since he's been doing a lot of flying. They did an ultrasound of his legs and found no clot there. Would this test be able to determine if he has a blood clot elsewhere in his body? From what I've read, it doesn't look like it would, but just not sure.
Kelly, New Jersey, USA, February 2, 2010

• Sorry to hear. This topic concerns CT Angiograms which are somewhat different from the type you're discussing. I would certainly discuss your concerns with the radiologists at the hospital.
Angioplasty.Org Staff, Angioplasty.Org, December 29, 2009

• My 20-year-old daughter had a PE (Aug. 2009) and has had 10 CT scans since. Now with the current reports, I'm concerned. She is experiencing hair loss, fatigue, and nausea. Is there anything that we can do at this point? What are her chances of getting cancer? To what cancers is she now more susceptible? If she was your daughter, what would you do?
Alison F., El Paso, Texas, USA, December 27, 2009

• Vijay -- you can gain a lot of information by reading our articles and interviews about CT Angiography in the Imaging and Diagnosis Center.
Angioplasty.Org Staff, Angioplasty.Org, December 15, 2009

• Hello Am 45, male. Quit smoking 16 years back. My father had a heart attack about 14 years back and a subsequent bypass surgery. He's 79 years old now and doing fine. I had borderline cholesterol and my cardiologist recommended Atorvastatin 3 years back and have been on a single 10mg daily dose. LDL is under control. I experience an occasional shortness of breath and tightness. Sometimes while climbing stairs and sometimes even without much physical exertion. Am considering a 64 slice CT angio to rule out any blockage. Any advice?
Vijay, Dubai, UAE, December 12, 2009

• Allergy to shellfish does not necessarily mean allery to iodine. But if you are, there are dyes that do not contain iodine. Be sure to discuss this with the physicians and technologists who perform the tests.
Angioplasty.Org Staff, Angioplasty.Org, November 25, 2009

• If I am allergic to shell fish i.e., oysters, lobsters, crabs -- I throw up and also faint -- am I allergic to iodine? If so, is there a non-iodine dye that can be used in a cardiac CT Angiogram? If not, it the Cardiac Calcium CT Scan the best option?
Donna, Toronto, Canada, November 23, 2009

• Ken -- yes and no. the CT angiogram can show the presence of a blockage and information about where it is and how severe it is. However, if intervention is contemplated, cardiologists will want a standard invasive angiogram first. So CT Angiograms are best for patients where the results of previous tests are unclear, and there is the distinct possibility of no disease. Whether or not to do bypass or stenting is a decision that should be made after seeing a complete angiogram of both sides of the heart and discussing the pros and cons of each approach.
Angioplasty.Org Staff, Angioplasty.Org, November 22, 2009

• I am 56 and recently had a nuclear stress test due to family history and high blood pressure. The doctor said that though the test did not show obvious blockage, that my heart efficiency went down during exercise. He wanted me to go in for a cardiac catheterization and said that if the test showed total blockage I would stay in the hospital for a bypass. My question is: does the 64 slice scan give you enough information to gauge the possibility of a bypass versus stent placement? If I need a bypass, I need a little time to try and set things up with my business for an extended leave. I really don't want to go in the hospital expecting maybe a stent or 2 and have to stay for a bypass.
Ken Wright, Fullerton California, USA, November 17, 2009

• Dave -- Kaiser is right that if you are already at medium to high risk, the CT Angiogram probably isn't the best test. An invasive angiogram in the cath lab would show specific blockages more clearly, but that's an invasive test. The usual approach is that if you are symptomatic (you have chest pains, etc.) you should be tested. And they are probably referring to the COURAGE Trial that showed no difference in mortality or heart attack for patients with stable angina -- whether they got stents or "optimal medical therapy". Statins, of course, are an important component of that therapy, so the results of COURAGE apply less to you than others. And if blockages are found in an angiogram, are they significant (read our article on the FAME study) -- not all blockages need treatment.
Angioplasty.Org Staff, Angioplasty.Org, November 10, 2009

• I'm white male 54 reasonable health. Run, ride and swim 3-5 times wk my whole life. Dad and Uncle died at 52 of heart attacks. Brother 53 just had severe one. I am allergic to statins. Am taking some Niacin. My healthcare provider Kaiser balked at request for 64 slice angio and/or a calcium test. Said they already know I'm medium to high risk. Want to monitor my cholesterol for now. Told me there is a study that says stents as a preventative measure aren't that effective in reducing heart attacks.. Should I push them for a more aggressive approach to analysis and/or seek outside scan. And then what? What if I have blockages do I push Kaiser for stents or something else. I have kids at home and a business and I want to be around to play with grandkids some day, not like my dad and uncle. ThanksDad2Five
Dave M., San Diego, California, USA, November 4, 2009

• I had a CT scan last month...Why? I don't know..I am experiencing no symptoms whatsoever.. I had a Thallium scan October 2008-indicating no blockages!!!! My Thallium scan-2007 showed no blockages!!! The ECHO did show a small calcium ring at the atrial valve (I'm 75!)....MY Cardiologist now insists on an angiogram and a stent!!!!..I got a 2nd opinion in Buffalo..The cardiologist there suggested that since I am Asymptomatic-to maintain my current beta blocker, diet and nutrition regimen,,The possible danger of an angiogram-with no cardiac symptoms "doesn't make sense,,,isn't worth the negative possibilities"I will appreciate your wanting to dive into this one---but Both my Buffalo cardiologist and I are suspicious....Further.. I had,,am still having an allergic reaction to the iodine injection...I was never informed of the related shellfish connection...Gradually, I am reducing the 2x per day of Benadryl -- Seemingly Healthy in Henderson, Nevada.,Charles F. Carpenter ,age 75
Charles F. Carpenter, retired-Erie County Government, Henderson, Nevada, October 19, 2009

• I am only 30 years old but I have crippling chest pain all the time and it gets worse with exercise, I have had a negative stress test, negative echo, no tropin elevation markers, cholesterol is 125, 15 negative EKGs while having severe bouts and a negative CTA but I'm not sure what to do next can anyone give me any help because I have seen 15 cardiologists and they keep telling me its in my head but I'm still in constant pain what is wrong with me??
Ciaran, Northern Ireland, September 4, 2009

• Arnie -- an invasive angiogram is not something recommended unless the patient is symptomatic and is at a risk level that would make the risk of the angiogram worth it. Same thing with a CT angiogram, except that the risk level of the procedure is lower. Although it is noninvasive, the imaging experts we've interviewed do not recommend a CT angiogram as a screening test for low risk asymptomatic patients, due to the radiation, cost, etc. However, many do think that a Calcium Scoring exam can be used this way. It is done either with an Electron Beam Scanner or a Multislice CT. The radiation is lower than a CT angiogram and it shows Calcium build-up in the arteries. It is completely non-invasive and, while not covered by many insurers, it is not expensive (in NYC it is possible to get one from a major hospital-based imaging center for $100). It has been shown to be a good predictor of coronary artery disease.
Angioplasty.Org Staff, Angioplasty.Org, August 10, 2009

• I am a 47yr old male in good shape who has been on Zocor for four years with good results. I have strong family history of heart disease (father had 2 attacks in early 50s). To put my mind at rest, I'd like to have either a heart CT or Angiography scan. Trying to figure out a way for my insurance company to pay for it.... Any recommendation on which I should push for? Dos and don'ts? Advice?
Arnie L., Oregon, USA, August 5, 2009

• Kevin in Florida -- you're absolutely correct!All major manufacturers now have low-dose options available. And it's not just the CT unit, but various techniques and protocols that are used by the technicians. Of course, they need to be trained in these. As quoted in our February 2009 article about low-dose CT, Dr. Michael Poon, past president of the Society of Cardiovascular Computed Tomography (SCCT) and Director of the Center of Advanced Cardiac Imaging at Stony Brook University Medical Center, stated:

The patient has to request this. Patients may read about this, may see the headlines, and then they need to go back and ask the imaging center, 'What method are you using to lower the dose?' And if they don't know what you're talking about, I would say, 'See you later!'

Thanks for the posting. This is a very important point for all patients to know about!
Angioplasty.Org Staff, Angioplasty.Org, July 23, 2009

• Recently had the 64 slice angiogram due to intermittent pain in chest. Fortunately, CD said test was normal. For those with radiation concerns I was told by technicians there is a "low dose" option on the new machines (2 months old-GE). FYI for those who may want to inquire about the machine that does their testing.
Kevin, Florida, USA, June 27, 2009

• Bryan -- CT angiograms are less accurate when there is a large amount of calcium, which can cause artifacts making it hard to judge. This may be why your cardiologist is tending towards the catheterization. Also there are low-dose options for doing CT angiograms. Although, as you state, other than shortness of breath, you're not experiencing symptoms. The question, as always, is how will the results of a test change your treatment?
Angioplasty.Org Staff, Angioplasty.Org, May 4, 2009

• I am a 55 year old male. A-fib in 2002 is under control with amiodorone and coumadin. Cholesterol is 154 while taking 10mg Lipitor. LDL is 95, HDL is 34. Blood pressure under control with Atacand. Normal nuclear stress text 5 years ago. Never any chest pain or other symptoms but have SOB when walking up stairs. Changed cardiologists last week. He did a complimentary Calcium CT Scan which scored 500. He suggested either a CT Angiogram or a catheterization. I felt he preferred the catheterization but left the decision up to me. Question: With such a high calcium score would you recommend forgoing the CTA and having the cath? Insurance coverage is not the issue as I am prepared to pay even if the insurance does not cover the CTA. But I don't want to have the CTA if I will have to eventually undergo a cath, particularly considering the radiation exposure. Thank you
Bryan, Tennessee, USA, April 28, 2009

• John B -- your experience points up that multislice CT angios are helpful in several ways. While the standard invasive angiogram is more accurate in terms of defining any positive results and the extent of disease, CT is extremely accurate in ruling out disease. In other words, if a CT angiogram shows NO disease, you don't have any. If it shows disease, then you would go to a standard invasive angiogram to find out more, and possibly treat the blockage(s) with medical therapy, angioplasty or bypass.
Angioplasty.Org Staff, Angioplasty.Org, April 25, 2009

• This is more or less an FYI for those folks that are reacting to results from 64 slice and echo stress tests. Approx 1 1/2 months ago I started experiencing shortness of breath with/without physical exertion. I am 50 yr male smoker, with family history of heart disease. Father and paternal Gfather died sudden death coronary occlusion at 59 yr. Went to primary care doc who suspected early lung issues. chest xray and several breathing tests were okay no mass or severe issues. Sent me to Cardiologist for echo stress test which came up abnormal after exercise. Heart rhythm and EKG fine, just looked like left ventricle was not adjusting after exercise, a sign of possible blockage. He wanted me in for fast angiogram. I instead went to another cardiologist for 2nd opinion (more recognized university hospital wit excellent rep) . He was less concerned and said this area of heart was known for false positives in this test. He had me go in for CT 64 slice angio. Results showed no narrowing of arteries however, 50% calcification in LMCA. He recommended immediate invasive angiogram. Needless to say after two weeks of this I was convinced I was headed for bypass. Stenting not an option in almost all cases with 50% or more stenosis in LMCA. In fact, stenting in LCMA almost never an option. Bottom line in for angiogram yesterday, results were excellent considering. LMCA less than 10% calcification, no blockage, all arteries showed no more than 20-30% calcification. Point here is two-fold. The good side is it scared me enough to wake-up and change my lifestyle. I consider this a blessed second chance THAT I will not ignore. Secondly, don't fear results too much from anything beyond regular angiogram. While these other tests have proved their worth and I am not about to challenge this, the absolute gold standard is the cath angiogram. Before anyone is ready to throw in the towel, wait for this test, it will tell you one way or another.
John B, Kansas City, Kansas, USA, April 21, 2009

• Reply to Mr rsva, Annandale, Virginia, April 19, 2009 post: In my opinion you should take your Dr's advice, and your symptoms most likely are due to the GERD, but since there is a documentation of a 40-50% Mid LAD stenosis in a CT Coronary angiogram, and most importantly you are worried, a Stress Myocardial perfusion test - using Tetrofosmine or a Stress Myocardial PET study - with N13 ammonia, is a definitive indicator. The % of a stenosis does not truly mean that there is a significant disease, but if functional studies like these mentioned also point towards a documented fact that there is a significant reversibility, then your worry might be justified. Well in any case given the circumstances the chances are remote, and a simpler test called a stress echocardiography also will give you the information. If this is really bothering you you could discuss these with your doctor, and he might suggest a best option scenario. If you CT was absolutely normal - then the negative predictive value would have been great but since it is not - a myocardial perfusion scan result of less than 8% reversibility, no dilatation, and no increased lung uptake between your stress test and rest imaging would confirm/ or mean a less than 2 % chance of you having an event in the next 2 years. others wise studies have shown us that good diet with risk factor control and statins and aspirin +/- other drugs have effectively reduced the stenosis burden (%) in time. so rest assured and discuss with your doctor.
Dr Ajith Joy K, Medlinks Cardiocare Pvt Ltd, , Thiruvananthapuram, Kerala , India, April 21, 2009

• I am a 38 year old male with a history of elevated cholesterol (220). Was a smoker over 10 years ago. Recently had a 64 slice that indicated a 40 to 50 % stenosis (mixed plaque) in the mid LAD segment. All other arteries were normal. I am on a statin and take a low dose Ca Channel blocker (Diltiazem 120 mg). However, I still continue to experience chest tightness. I am physically active (run 5-6 miles a day, 5 times a week). My doctor suggests that the statin therapy with yearly monitoring is sufficient, but the symptoms are worrisome. I do have GERD too and most episodes of chest tightness occur after I drink coffee, however the results of the 64 slice always make me wonder if I need to run to the ER when I have the episodes of frequent chest tightness. I would appreciate any comments and suggestions.
rsva, Annandale, Virginia, April 19, 2009

• Reply to Forum editor's posting. Thanks for advice on OMT. I did a CT scan because I had some persistent chest muscle pain on my left side after waking up and a few incidents of what I thought was arrhythmic heart-beat. Also a couple of my sedentary life-style friends died of heart-attack which gave me a big scare. No family history of heart-attacks only diabetes. No recent arrhythmic heart-beat. Chest muscle pull better when I sleep more on my right side and eased up on the chest press poundage at the gym. Regard.
David T., Vietnam, April 19, 2009

• Olga -- there is a lot of information about the different tests in our Imaging and Diagnosis Center. Have you had any tests as of yet?? As for radiation, you're certainly asking the right question -- we are a bit surprised that you haven't gotten a clear answer. Be aware that a nuclear stress test has as much if not more radiation than a standard CT scan, although many of the physicians we've interviewed are doing CTs at very low doses. We can't really recommend a specific facility -- we do know that the program directors of ISET, the big annual interventional meeting in Florida, are with Baptist Cardiac and Vascular Institute of Miami. A training symposium on Cardiac CT is part of that meeting, so that might be a place to start. Good luck and let us know what you find out.
Angioplasty.Org Staff, Angioplasty.Org, April 16, 2009

• My cardiologist wants me to have a 64 slice ct of the coronaries. I don't want to because of the amount of radiation i have had in the past (I'm 44 yrs old). Does a cardiac MRI show blockage in the coronaries? Can a stress echo also demonstrate coronary blockage? I am finding that every facility that I call to see if they are using radiation reduction techniques for cardiac ct can't give me a straight answer. I am speaking with the technicians who directly do the exams. How and from who can I get the answer that I need. I live in South Florida, if you know of a facility that has these methods in place, please let me know.
Olga, Florida, USA, April 15, 2009

• David -- a 20-30% lesion is below the threshold for an intervention -- it's certainly not considered obstructive. You're an ideal candidate for reducing your risk factors by modifying your lifestyle (diet, exercise, smoking cessation, etc.) and medical therapy to keep cholesterol down. As for fenofibrate supplement, we always urge patients to work along with their cardiologist in terms of any medications, both prescrption and over-the-counter, as well as lifestyle changes. All these things together are what is called OMT, or Optimal Medical Therapy. By the way, why did you get the CT angiogram in the first place: symptoms? family history?
Angioplasty.Org Staff, Angioplasty.Org, April 15, 2009

• I am 48 yrs old Chinese male of reasonable health with relatively high BMI 27, high lipids and Type 2 diabetes. Did a CTA 64slice MSCT aquilion coronary angiography. Radiologist concluded I had "a 20-30% lesion of the Prox LAD/stenosis of LAD 1 by mixed plaque. Diagonal branches no stenosis noted". Report also said all other areas " no plaque detected, no stenosis". I would like to know how serious is the above stenosis of LAD 1 and what I can do to mitigate it apart from diet, exercise. Doctor has put me on 20mg Lipitor statin theraphy for time being. is it advisable to supplement with fenofibrate as well. Thank you.
David T, Vietnam, April 14, 2009

• I'm 77 yo female in reasonably good physical condition (sportive) but bad family history. After 3 years of SOB with exertion, upper shoulder and throat pain when chilled and 3 negative Nuclear Stress tests, my cardiologist finally ordered the CT Angiogram. It reflected blockage (circumflex) and with Catheterization showed 90%. Stent implanted and symptoms relieved for most part. Question is why the CTA not done first since Nuclear stress practically equivalent for radiation and definitely not as diagnostic? Sign me 'a crusty old broad with lifetime in Medicine' still In pursuit of excellence for my field.
Patsy Ray, Kinderhook, New York, USA, February 3, 2009

• Golam -- Results of major studies of CT angiograms is that they are 98-99% accurate in negative predictability (ruling out coronary artery disease). In other words if the CTA shows no disease, you don't have any. This must be modified by certain clinical conditions, such as high calcium that may block the image and make it less reliable. Also, of course, the CTA needs to be done well by an expert. This is why we (or anyone other than a cardiologist trained in reading CTAs) cannot give you advice on this matter. Nothing in this email or on our site should be taken as a substitute for medical advice. Use this information to discuss the situation with your doctor, but your doctor is always the best source of advice.

We can say, however, that most CTA experts feel it is more accurate than a nuclear stress test -- which tends to be less accurate in women. We urge you to read over our section on Imaging, including the many interviews with experts. We also suggest that you consult a cardiologist who is expert in reading a CTA. Again, CTAs are very reliable when done in the proper patients and by a cardiologist or radiologist trained in CTA. While their positive predictability is perhaps not yet as great as a standard catheter-based angiogram, its negative predictability (ability to rule out disease) is 98-99% in all major studies done. Let us know how things progress.
Angioplasty.Org Staff, Angioplasty.Org, August 11, 2008

• How reliable is a 64-slice CT Angiogram in comparison to a catheter to determine blockages in the heart? Cardiologists in Bangladesh and India seem to prefer the catheter and suggest that a CT Angiogram can only reveal 80% of the heart's condition. My wife, aged 40, weight, 100 Kg, tested positive in a stress test known in Bangladesh as CTT. Her cardiologist instantly diagnosed her as having provocated ischemia and suggested that a catheter be done immediately. Later, I took my wife to India where a CT Angiogram showed that she had no blockages. In spite of the finding, the Indian cardiologist also said that a CT Angiogram is only partially reliable. Thanks.
Golam Sarwar Chowdhury, British Council, Dhaka, Bangladesh, August 11, 2008

• Joann -- a CT angiogram performed by a cardiologist or radiologist experienced in this imaging mode, along with a 0 Calcium score, is pretty strong evidence against any coronary blockages (CTAs have been shown to have a 99% negative predictability for CAD). Additionally, nuclear stress tests are known for false positives, especially in women. We certainly aren't arguing against your cardiologist's opinion, however. What was his reaction to your 64CT??
Angioplasty.Org Staff, Angioplasty.Org, July 2, 2008

• in 03/07 I went to a cardiologist to ask about the medication (Flecainide) I was taking for paroxysmal SVT. My EKG showed sinus rhythm with 1st degree AV block. He gave me a nuclear stress test and it came back positive. He said it showed moderate filling in LAD. He scheduled a catheterization. I opted for a 64CT scan at another location (did not realize there were any in my area nor was I offered a choice). It came back normal with a 0 calcium count. Can I trust the results and could the first test have been a false positive? 15 mos. and I still worry.
Joann, Tampa, Florida, USA, June 27, 2008

• I live in South Carolina and would like to get scanned with a 256 slice machine for better accuracy. What is the nearest facility that has one of these and how much does it cost as my insurance will not pay it. Thanks.
J.B., South Carolina, USA, June 17, 2008

• Michael -- we are not doctors so can't advise you, other than to say that a PET scan is not the same as MSCT. A PET scan is a functional test -- it uses radioistopes to measure the perfusion, or blood flow, in your coronary arteries. An MSCT or Cardiac CT scan shows an actual image of your heart and arteries. Although you already had a standard invasive angiogram which does the same as a Cardiac CT, only more accurately -- so there'd be no reason to get a CT. But since you're a left dominant, and those arteries are still open, that's good, and your doctors may be saying that the risk of doing an angioplasty on the right outweighs the relatively small benefit you'd receive.
Angioplasty.Org Staff, Angioplasty.Org, June 17, 2008

• Question to the Doctor. I am 65 yrs old. Had quintuple bypass 21 years ago. Since then under regular Cardiologist's care - medication for Cholesterol ,ACE Inhibitor, ASA , Niaspan to raise HDL , B12 / folic acid suppliment daily to lower high Homocystyne , excellent heart patient dietary habits , regular exercise at the Y ( tred mill , weights etc). Then started with some symptoms again while exercising 2 years ago. Had Angiogram which showed original bypass of RCA had totally occluded ( disappeared ) and the RCA blockage was now twice as extensive. Bypasses on CX ( now original blockageis twice as extensive ), LAD , OM , still " widely patent ( open). Bottom line - Cardiologist said I still had excellent blood flow on left side , with 70% result of MUGA test. Said blockages were too extensive and dangerous to perform Plasty for a stent - so staying with lifestyle and meds described above. I went to Ottawa Heart Institute for a PET Coronary Scan to dble check the Angiogram results and obtain a second opinion. Dr. said there wasn't a surgeon in Canada that would touch my blockages.
So far still only getting symptoms after about 10 - 15 minutes on tred mill. And keeping my fingers crossed ! Can you tell me if the PET Scan is the same procedure as the MSCT . If not , do you think I would benefit and is it available in Ontario? Thank you.
Michael Higgins, Mississauga , Ontario , Canada, June 16, 2008

• Thomas -- we can't give medical advice and you should ask your doctor these questions. The first condition you probably saw is interstitial pneumonitis which is a disease of the lungs. The second is a diseased aorta, with fatty deposits. A cardiac CT scan would yield infomation on both conditions, even though the first is not a cardiac disease, but the CT scan covers the upper chest.
Angioplasty.Org Staff, Angioplasty.Org, June 14, 2008

• During a recent medical treatment followed by a continuous cough, I had undergone an x ray and in the result it was written as Intestitious Pnemonitus and Arithromities Aorta. On consultation doctor adviced for CT Angeogram. Is it really required ? Last 10 years I am taking Omeprasole capsule for Hayatus Hernia. Please advice.
Thomas, India, June 11, 2008

• The 64 slice scanner calcium score may be a slightly higher radiation dose -- but this varies among the difference units and also the operators.
Angioplasty.Org Staff, Angioplasty.Org, June 6, 2008

• What is the difference in radiation for just getting a calcium score on a 64 slice scanner vs. an ebt scanner?
EK, Pennsylvania, USA, June 2, 2008

• Joe -- read below about CT Calcium scoring, which is much lower radiation than a CTA. Whether this is appropriate is something your cardiologist and you should discuss. As you said, you are asymptomatic, so you have to ask, "How will a test affect my therapy?" If you do go for a CTA, inquire if reduced dose techniques are being used.
Angioplasty.Org Staff, Angioplasty.Org, May 17, 2008

• I am a 65 year old caucasian male, weight 144, height 5'7". A calcification was found in my LAD during a CT scan for broken ribs in January. A CTA has since been recommended. I have a strong family history of CAD, but have never had symptoms or problems and have never smoked. I am on Lipitor 20 and Lisinopril 5, fish oil supplements, and .81 aspirin daily. My LDL Choles. is 48.2; HDL is 68.6. I run 20 miles/wk and lift weights 3 times/wk. Because I've already had 4 chest x-rays and a CT scan in 2008, I'm concerned about the added radiation from a CTA. Since I'm asymptomatic, I wonder about the appropriateness of a CTA in my case. What would be a reasonable course of action for me to take?
Joe S., New York, USA, May 16, 2008

• A.R. -- last question first. 1760 roughly translates to 30 msv. This is almost exactly twice what a non-gated 64 slice CT angiogram would be -- non-gated means not using any of the currently-available gating dose reduction techniques (offered in one form or another by all the manufacturers). To arrive at this, we used a conversion figure from an April 2006 article in the Canadian Association of Radiology Journal. We're curious what your PCP had to say about this. A scan for a Calcium CT score only, which you say is what his prescription was, is very low -- low enough that a number of prominent imaging cardiologists have been recommending it as a general screening tool (see our interview with Dr. Harvey Hecht). A note here is that Toshiba recently introduced a new 320-slice scanner which actually uses less radiation, because it is able to get the entire heart (and chest) in a single rotation.
Angioplasty.Org Staff, Angioplasty.Org, May 8, 2008

• Around February of this year I had a ct heartscan, my pcp referral was for one heartscan for calcium score due to my chest pain and a abnormal cholesterol level, the facility I went for the scan took a two separate scans, whole chest area and the heart, I believe they subjected me to unnecessary radiation exposure by two scans, If i have been informed of the procedure and the exposure of radiation level I would have refused to take the scan, I am clearly convinced that their financial interest was primary than the patient care, however the calcium score was zero, and I had normal ct of the chest, that was a toshiba 64 multislice ct scan, due to this exposure I am concerned about the risk of developing lung cancer, and I feel somewhat uncomfortable in my chest region and weak since then, the radiologist said the dose I had was 1760 mgy-cm (what is this will be in mrem or msv?) Is my concern well founded? Thanks for your any advice!!
A.R., Chevy Chase, Maryland, USA, May 8, 2008

• Cat and Kathy -- the radiation from a CT angiogram is roughly comparable, or slightly less than that from a nuclear stress test. Some techniques are now being used that bring the dose even lower. If you read our latest interview with Dr. Harvey Hecht of Lenox Hill Hospital in NYC, you'll find that he (and a growing number of imaging experts) feel that the CT angiogram will replace the nuclear stress test as the definitive diagnostic test for coronary artery disease. Kathy, your situation, like Kotra from India, is typical. A nuclear stress test showed positive, so he gave you a CT which showed that the nuclear stress test was a false positive. Dr. Hecht would probably ask, "Why give the nuclear stress test at all? We've learned nothing that the CT wouldn't have shown and we've exposed the patient to more radiation." He would start with a CT angiogram and if blockages are shown, proceed to a catheterization with possible angioplasty. Studies have shown that if the CT angiogram finds no disease, then you don't have any. The negative predictability of CT is 99%. A cath is more invasive and carries a small risk, but about 3% of complications, usually at the catheter site (bleeding, nerve trauma, etc.). Cat -- your decision to get the CT (instead of another nuclear stress test) is a valid one. Kathy -- your doctor was correct to send you for a CT instead of a cath, but soon he and others will hopefully be skipping the nuclear stress test altogether, except in certain specific situations.
Angioplasty.Org Staff, Angioplasty.Org, April 22, 2008

• I am a 49 year-old woman who had two stents in my LAD after a 90% blockage was found five years ago. I have recently been having consistent chest pain when exercising. I am generally able to continue on the treadmill despite the pain, and it stops immediately after I stop the exercise. Because of this symptom and my concern, I am going to get a CT angiogram. Does this sound like the right decision? A stress echo six months ago was fine. In addition to the original angioplasty, I have had three thallium stress tests (none in the last 3 years), so am concerned about radiation. But not knowing what's causing my pain is driving me nuts, so it seems like the thing to do. Your thoughts are appreciated.
Cat, New York City, USA, April 18, 2008

• Female, 47...I just had a 64 slice cardiac cat scan because my nuclear stress test came back abnormal. The doctor said it showed a blockage and that I should go for the scan because the alternative was too invasive. I am healthy, thin and don't smoke and have occasional drinks so I was surprised. Doctor said he thought it was a false positive but to go to double check. It came back all clear thank God. I was really concerned about the radiation and spoke to the doctor about my concerns and he said the alternative, cardiac cath, was too invasive but I still worry about the cumulative effect the two tests will have on me. I felt like I had no alternatives. Although relieved I am so worried about the radiation. Did I have any other alternatives? How bad is the radiation from these tests?
Kathy P., New York, USA, April 14, 2008

• Kotra -- lots of questions here, but the picture that's been painted is that you have mild multivessel coronary artery disease and that your doctor has decided to manage you, for the time being anyway, with medication (a statin to lower cholesterol, clopidogrel to prevent blood clot formation, and a beta blocker for blood pressure and angina). You didn't mention whether you were having symptoms, like angina when exercising, but given that the CT showed no severe blockage, he's following "best practice guidelines". You have risk factors -- and you should lower any under your control (diet, exercise, smoking, etc.). Your Calcium Scoreof 103 is bordering the mild to moderate disease category. You can't really get rid of plaque (although intense statin therapy has shown small reductions). But you can slow the progress of the disease. Calcified plaque is hard and usually older. LAD = Left Anterior Descending artery, the main artery on the left side of the heart. LCX = Left Circumflex artery which branches off of the LAD. RCA = Right Coronary Artery the only artery on the right side. You should always discuss your other medications with your cardiologist. It's very good that you caught this condition before severe blockages developed, possibly causing a heart attack. Hope this helps.
Angioplasty.Org Staff, Angioplasty.Org, April 11, 2008

• Recently I had a CT Coronary Angiogram after a stress test result was positive. The findings of CT Coronary Angiogram is: "a) CALCIUM SCORE :103 B) RIGHT DOMINANT CIRCULATION C) LAD: Ostium, proximal and mid segment shows mixed plaque with mild narrowing. Distal segment is normal D) LCX: Ostium and proximal segment shows mixed plaque with mild narrowing. E) RCA: Ostium shows calcified plaque with mild narrowing. Proximal segment shows mixed plaque with mild narrowing. f) COMMENTS: Mild multivessel CAD" My cardiologist has prescribed the following drugs: 1) Atorvastatin Calcium 20 mg daily one tablet 2) Clopidogrel 75mg daily one tablet 3) Metoprolol Succinate 25 mg daily one tablet. Review after 3 months. I shall be glad if you will please advise: a) What is the risk factor in this case? b) Is the calcium score normal? c) Is there any chance of getting rid of the plaque with the above medication? d) the difference with mixed plaque and calcified plaque? e) What are these LAD, LCX, RCA? f) Some 6 months back I have undergone bone density test and am diagnosed as "Ostiopanea" and I am using Calcitriol .25mcg one tablet per day. May continue with this Calcitriol in addition to the medication given by the cardiologist? Kindly clarify.

• Howard -- the CT is showing something. It may be an artifact, but a growing number of cardiologists feel that standard angiography is not necessarily the "gold standard". Read our current interviews with imaging experts Dr. Harvey Hecht and Dr. John Hodgson for some in depth information about areas where angiography may not tell the whole story. Did your cardiologist use intravascular ultrasound (IVUS) -- an imaging technology which directly images the interior of the artery? Dr. Hecht discusses your exact situation where a CT shows something, but angiography does not, -- in his opinion, in such a case, especially where there are symptoms, IVUS or FFR (a pressure measurement) should be mandatory.
Angioplasty.Org Staff, Angioplasty.Org, April 1, 2008

• I have had two separate 64 slice CT scans. The first one in November 2007 found calcification in the LAD and a blockage on the right side. I had a subsequent catheterization. During the procedure, they put in six stents in the LAD. The CT scan identified a blockage in the right artery but the MD claimed it was not there during the angiogram. I was not feeling well after the procedure and in January 2008, I had another CT scan. I was told it was fine. However, yesterday I was told the same blockage was found in the right artery. The MD claimed he ignored it again because he did not see it during the angiogram. What is the reality of having two false positives show up in the same spot months apart? What do I believe the MD's eyes or the CT scan?
Howard G., New York, USA, March 27, 2008

• Officer Car -- the subject of your posting is certainly in the news today. The chief issue covered in our article "Medicare Reverses Decision to Limit Coverage of Cardiac CT Heart Scans" is what tests insurers will pay for. You had symptoms of coronary artery disease (CAD) while running, although those could be attributed to other causes as well. So the question is how to test whether you have CAD or not? Interestingly enough, many cardiologists now think that multislice CT may replace many of the nuclear stress tests now given. The nuclear tests actually carry an equal or greater radiation dose than CT and they have a higher false positive/negative rate. It's possible that the nuclear stress test might also have shown nothing major. But CT is 99+% accurate in ruling out CAD. It's not a test that estimates your possibility of CAD -- it's a direct visual look at your arteries. If you have a blockage, you can see it! As for screening people "off-the-street", none of the cardiac societies advocate screening asymptomatic patients with CT. But you were not asymptomatic. By the way, the very first angioplasty patient, Mr. Adolph Bachmann of Zurich, Switzerland, was just about your age when he was "ballooned". That was over 30 years ago. We just attended a dinner with him last fall and he's still very active and happy! Good luck and keep in touch.
Angioplasty.Org Staff, Angioplasty.Org, March 13, 2008

• Why did the old fashion stress test fail me???? I am a 39 year old state Trooper who runs 30 plus miles a week. I consider myself a person who is in good shape an one that is familiar with his body. About 6 months ago I started developing neck an shoulder pain while running. I advised my Doctor of this and he wrote me a script for a nuclear stress test. My wonderful insurance Aetna Health Care declined the test stating I didn't fit the criteria to qualify, but that they would pay for a regular stress test. I took the stress test and passed it with flying colors. I was still experiencing the same symptoms when running. Then one day a co worker informed me that a CT test was being administered to law enforcement personal near Atlantic City. Free. I took the test and found out I had a 95% blockage in my LAD. I now have three stents. Thanks, Aetna
Car, New Jersey, USA, March 13, 2008

• Kotra -- the dual source CT is a technology that has been developed by Siemens Medical to give a higher resolution image by interfacing two different angles. It's one of the second (or third) generation developments in CT angiography. Other manufacturers have their own technological advances -- Toshiba just showed a 320-slice system, GE and Philips have their own current innovations. Most new state-of-the-art systems are going to be highly accurate, no matter which technology is used.
Angioplasty.Org Staff, Angioplasty.Org, March 11, 2008

• Is there any difference between "64 Slice Single Source CT " and "Dual Source CT" ? Kindly advise.

• Gomathi, The Forum Editor has replied to your questions. There are a few additional points I would make - the primary factor in heart disease is a family or genetic history of heart disease. Smoking, even in adolescence is the next most important factor, before diet and exercise, which are far less important. In talking about CT scans and Angiograms, there is the resolution of the arterial measurements to be considered. Angiograms have about 0.1mm resolution, whereas CT scans have at best about 0.3mm resolution. So measurements made by angiograms are considerably more detailed and reliable. Finally, there is the issue of x-ray dose. The chance of death due to the x-ray dose is about 1:2000 or thereabouts. Early model CT scanners gave a much higher dose than the latest models that use faster scanning. The dose on these is more like that in an angiogram. You should ask about the model of CT scanner and dose. Finally there is the cost - CT scans are often a relatively expensive way to image and measure the heart's arteries. Hope this helps.
Jaques, Australia, February 14, 2008

• Gomathi -- what besides curiousity prompted your father to get the CT angiogram? Is there a family history of heart disease? Guidelines state that anything less than 50% narrowing should not be treated, other than medically or with lifestyle change. Sounds like diet has been good. Exercise and correct weight is also important. As well as making sure cholesterol levels, blood pressure, etc. are all normal. You should discuss this, as well as the report, with a cardiologist -- 30-40% narrowing may sound frightening, but the real question is whether this narrowing is obstructing the blood flow. It's somewhat unknown what the "normal" amount of narrowing is -- as people age, plaque can build up, but it doesn't necessarily mean they're being impacted by it. What does your doctor say?
Angioplasty.Org Staff, Angioplasty.Org, February12, 2008

• Dear All, My father did not have any symptom for chest pain. His health was in good condition, but we had a curiosity to do a CT scan. So we did CT Coronary Angiogram and in the report we find in the left Main "Discrete eccentric mixed plaque with positive remodeling causing 30-40% Luminal Stenosis in" and Proximal: up to 40% luminal narrowing at the ostium. Could you please let me know how serious is this and how to proceed further on the treatment (Angioplasty or medicine) Note: No smoking, No Drinking, Rarely Non Veg, No Oily foods and no coconut... in food. In spite of all these we found 40% really depressed..... It would be great if you can provide good suggestion. Thanks.
Gomathi, EDS, India, February 12, 2008

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