Multislice or Multidetector 64 Slice CT Angiogram

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

Current Postings (124):

• A.R. -- last question first. 1760 Mgy.cm 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, 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.
KOTRA RAMA MURTHY, SBI, HYDERABAD, INDIA, April 7, 2008

• 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.
Forum Editor, 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.
Forum Editor, 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.
Forum Editor, Angioplasty.Org, March 11, 2008

• Is there any difference between "64 Slice Single Source CT " and "Dual Source CT" ? Kindly advise.
KOTRA RAMA MURTHY, SBI, HYDERABAD, INDIA, March 9, 2008

• 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?
Forum Editor, 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

• Jane -- visualizing stents with CT angiography is tricky. The newer more sensitive 64 slice systems are pretty good, but there are a lot of variables. What kind of problem with the stent did the CTA show? As you can read in our special section on Intravascular Ultrasound, even invasive angiography (catheterization) can miss whether or not a stent has been perfectly implanted. We're assuming, from your post, that you are not covered by insurance, but a potential problem with a stent should be dealth with. Perhaps you could talk to the doctors involved (the interventional cardiologist who did the stent and the CT reader) and ask them if they would agree to a quick consult at a reduced fee?
Forum Editor, Angioplasty.Org, January 5, 2008

• I am a 53 year female. At 51 I had a cardiac catheterization after a myocardial infarction. My LAD had eccentric stenosis of 60% in mid segment after diagonal branch. The LAD was totally occluded distally with thrombus. AngioJet thrombectomy on thrombus and distal LAD was successful, however I still continued to have distal occlusion near the apex. A 2.5 x 23mm Cypher stent that wrapped around the apex was deployed in order to establish a better distal flow. Recently my regular doctor ordered a CTA. He told me that the doctor that read the CTA found a problem with the stent. He made an appointment with me to see the doctor that put the stent in during the catheterization. Because of financial problems I am unable to afford the visit to see the doctor that put the stent in. Should I be concerned about trying to get checked for this concern my regular doctor told me about after the results of the CTA?
Jane, Ohio, USA, December 29, 2007

• I have had several coronary stent procedures and am interested in assessing them for restenosis as I have had this occur 2 yrs ago. I am interested in obtaining a ct angiogram. However I have some renal insufficiency (serum creatinine 1.8 and bun 29). If I decide to obtain the ct study what would be your pre-study recommendations to prevent contrast nephropathy i.e. acetylcysteine, etc., or should I forego the ct study?
Harold, Colorado Springs, Colorado, USA, December 19, 2007

• Craig -- your cardiologist is correct -- a high Calcium Score by itself doesn't indicate coronary artery disease (CAD) -- and most 16 slice CT scans don't have a high enough sensitivity to see soft or "vulnerable" plaque. What mutlislice, or 64-slice CT angiography is excellent for is to rule out CAD, definitely. There is a consensus statement that was authored by the major heart societies (AHA, ACC, SCAI, SCCT). It took some time to put the guidelines together because unnecessary testing is an area of concern for all. Additional radiation from the 64-slice CT is also a concern, but it's a bit less than what you'd be getting from a nuclear stress test and, with newer equipment and methods, it's far less. If you read some of the interviews with imaging experts in our Imaging and Diagnosis Center, you'll see one clear difference between stress tests and a CT angiogram. The stress test is a functional test -- it shows if the flow of oxygenated blood to the heart is less than optimal. It shows a result, but not the cause. A CT angiogram is a direct view -- it will show if there is are no blockages with 99% accuracy. We can't advise you one way or the other. This is a conversation you should have with your cardiologist and you should discuss the cost/benefit -- not forgetting that putting your mind at ease would be a benefit. One caveat -- CT angiograms are a bit less accurate when in the presence of a lot of calcium, which acts as a shield.

And Krystal -- an infarct would mean that at some point your husband had a heart attack and some of his heart muscle is damaged -- your husband is very young for such a diagnosis. EKGs are the first line of testing and are by no means a test on which a firm diagnosis can be made. But an abnormal EKG should lead to additional testing. Discuss this with your doctor for sure.
Forum Editor, Angioplasty.Org, November 12, 2008

• My Husband is 24 and has history of heart problems. He recently had a EKG done and it is reading abnormal. He has several of them and they are all abnormal. It reads Interior Infarct. I would like to know what that means and what I should do? Thanks.
Krystal, North Carolina, USA, November 9, 2007

• 52yr/M/asymptomatic/ My father had a triple bypass in 1973 at 48 years age and lived another 30 years. My wife is also a heart nurse. For that reason I had all the stress tests done three years ago. I am an amateur climber and do a great deal of exercise, mainly Stair Master and hiking uphill with heavy loads, 40 to 65lbs. I am very fit. My stress test indicated no problems. I then asked the cardiologist about a calcium scan, which at the time was an 8 or 16 slice. He laughed and said not to get paranoid because I was fine. He said I simply could not do what I did on my nuclear stress test if I had any problems. I did the calcium scan anyway and scored about 260 which put me in the 90th percentile. My blood work was good and my cholesterol was normal. Even so the cardiologist put me on one baby aspirin per day and zocor. I have been on this regimen for three years. Now the Heart Hospital has the 64CT scanner and I am wondering if someone who is asymptomatic but had a high calcium score should get the 64CT angio scan? My cardiologist told me hard calcium wasn't what I should worry about. He said it was the soft plague that gets you in trouble and the 16 slice didn't pick up soft plaque. What is the current day consensus about an asymptomatic person who is very fit but has a high calcium score, undergoing the more comprehensive 64CT angio tests?
Craig Blankenship, Edmond, Oklahoma, USA, November 8, 2007

• Joan -- we are not in a position to either offer medical advice or to second-guess the advice of a qualified MD. If you are concerned about whether you should get a CT, you can browse through the "Appropriateness Guidelines for CT", authored by the American College of Cardiology as a guide for when a Cardiac CT is indicated. You will note a complex scoring system which measures the various trade-offs, one of which is the radiation dose from a typical Cardiac CT - roughly equivalent to what you would get from a standard invasive angiogram. One question to ask your physician is how will the results of this test affect any course of treatment?
Forum Editor, Angioplasty.Org, October 7, 2007

• My doctor wants to do this as I have a family history of early onset CAD. I am 54 and I have no symptoms or any other risk factors. My CT heart scan 3 years ago was excellent--no calcium, but he says I could still have soft plaque. An echo stress test was good. VAP test was pretty good. He'd like me to take plant sterols and fish oil to get my LDL from 82 to the 70's, and to change the small dense LDL pattern. I have tested negative for inflammation. What concerns me is the radiation, the possible reaction or ramifications from the iodine dye and serious (though rare) reactions to beta blockers. Thank you.
Joan D, Denver, Colorado, USA, October 3, 2007

• Reimbursement for CTA is a big issue. It has changed and will continue to change as more studies are published showing its accuracy. The major cardiology associations have updated their guidelines for use of CTA and the SCCT, which specifically deals with CT, is active in advocating for increased reimbursement. You might want to contact them directly. We're curious -- what was the result of the CTA??
Forum Editor, Angioplasty.Org, October 3, 2007

• I had a CTA three months after having a cardiac catheterization and a stent placed in my anterior descending artery. The need for the CTA was persistent angina following the placement of the stent. Blue Cross Blue Shield of Michigan is refusing to pay for the $1800. procedure (They categorize as investigational). BSBS would have paid for another cardiac catheterization that would have cost several thousand dollars more! Any suggestions on how to get this paid, different coding etc.?
Gary C., Michigan, USA, October 3, 2007

• Vy -- you are correct. These is no femoral or radial arterial puncture done in a CT Angiogram -- only an IV. But definitely let your CT doctor know about your Coumadin prior to the appointment in case they have a specific protocol to follow.
Forum Editor, Angioplasty.Org, October 2, 2007

• I am scheduled for a CT Angiogram due to a chronic pulmonary embolism. I am on Coumadin for this condition. My hemotologist thinks that this procedure would make it necessary to stop Coumadin for a few days before the procedure because "Any kind of angiogram involves an incision" IS this true? Isn't this procedure done with a conventional vein IV?
Vy, California, USA, October 1, 2007

• ST -- beautiful mountains! Wish we were there. A CT Angiogram (64 slice) has been shown to be highly negative predictive (99+%). In other words, if the CT shows no disease, you can pretty much trust it. It's a bit less accurate in showing positives, because there can be false positives due to a number of things -- although it's still pretty accurate, and getting moreso all the time.
Forum Editor, Angioplasty.Org, September 17, 2007

• I am a 55 yo postmenopausal female who hikes vigorously in the back country of Glacier National Park. My stress test yesterday yielded ST depression. I will soon be undertaking a CTA. Is this the logical next step or what other possibilities exist? How definitive is a CTA?
ST, Montana, USA, September 14, 2007

• What is the upper permissible limit of radiation a patient can receive in his/her lifetime? How many times in a year a patient can be exposed to the radiation?
Amruta, Siemens, Bangalore, INDIA, September 11, 2007

• Betty -- 64-slice CT actually uses a similar dye to standard angiography -- Magnetic resonance does not. Although if you might have renal insufficiency, make sure that gadolinium-based dye is not used in your MR. There are non-iodine dyes and also precautionary protocols to pre-treat people who are allergic to iodine-based contrast. We can't recommend a hospital -- perhaps a query to the Society for Cardiovascular Computed Tomography (SCCT) would help you find a qualified imaging center.
Forum Editor, Angioplasty.Org, August 14, 2007

• I have hypertension that has become difficult to control, my cardiologist wants me to have renal and cardiac catheterization. I am allergic to iodine dye and was wondering if CT or MRI would be better for me to have. I understand the 64-slice CT requires no dye. I live in Arkansas and would also like to know the nearest hospital where I might have this done. I can travel somewhere else if it is safer for me to have. Thank you, Betty Ellis
Betty Ellis, Newport, Arkansas , USA, August 12, 2007

• Darlene -- the contrast dye used for a 64 slice CT angiogram carries the same cautions as the dye used in a standard invasive angiogram. However, there are dyes that are less toxic to the kidneys -- and in some cases, the dye can be diluted more than usual, but you need to have a very good imaging system to get the best resolution, whether you go CT or invasive. It makes no sense to subject a patient to any test if the test is not going to provide the proper information. Your situation is not uncommon, a significant percentage of patients with coronary blockages also have blockages in the renal artery, causing kidney dysfunction -- and vice-versa. Cardiologists who do these procedures have a number of protocols in place to protect the kidney (keeping the patient super-hydrated, etc.). Your nephrologist should discuss these issues with your husband's interventional cardiologist to make sure every protocol is followed. The CT angiogram is definitely less-invasive and may be the appropriate test if your husband is in that grey "indeterminant" area. However, this is a decision that needs to be made by you with both of your doctors. If there's a good chance your husband is going to need an invasive angiogram anyway (or angioplasty/stent) then it would be best to go right to that test and lessen both the contrast dye and radiation exposure.
Forum Editor, Angioplasty.Org, July 22, 2007

• My husband , age 72, is diabetic with some kidney impairment. His cardiologist wants to perform an angiogram because of his stress test results but is leaving the decision up to my husband and his nephrologist. Would a 64 slice CT involve less contrast and lessen the amount of damage caused by the contrast dye?
Darlene K., Arizona, USA, July 18, 2007

• Annie -- it would be good if the cardiologist who did the invasive angiogram could contact the radiologist who did the CT and perhaps it could be a learning experience for both. We're awaiting the results of the CorE 64 trial in the fall, which pits 64 slice CT angiograms against the standard invasive angiogram -- but studies done with 16 slice units show a very high negative predictability: if the CT shows no disease, there is none. 16 slice fell down a bit on positive predictability, but it was still pretty accurate -- mainly not doing as accurate a job with intermediate blockages. Not sure what to say about a severe blockage turning out to be none at all. We would urge all posters to read through the various articles on our Imaging and Diagnosis Center, especially our current interview with Dr. Stephan Achenbach, who addresses some of these issues.
Forum Editor, Angioplasty.Org, July 18, 2007

• A month ago I had the 64 slice CT Scan I paid for myself.It was a preventative due to family history. I had all the stress tests and a battery of other things for a few bouts of chest pain. This week I had an angiogram. Reason, the CT scan radiologist said I have a severe blockage. When the Doc went in he said NO blockage. Radiologist must have read it wrong! Why I am told my heart is the less than 5% that has a right artery that enters different spot on my heart. Why could they not see this??? I am suspicious now. Also I am told the normal heart has pressures around 5cm and mine is 30cm. I have used nitro for severe chest pains now on Avalide 150/12.5 Metoprolol - Toprol XL 25 mg 81 mg aspirin So what is interior heart pressure and how do you fix that?
Annie, Ohio, USA, July 15, 2007

• Rick -- do you mean "should I be thinking about an angiogram"? An angioplasty is a treatment for a blocked artery, and so far tests have shown you have none. Have you had a Calcium scoring exam? This involves much less radiation than an all-out 64 slice CT angiogram, and might help relieve your concern. Were your brothers' heart attacks caused by a blocked artery? Or by a rhythm dysfunction? Runners and other atheletes sometimes develop a slightly thickened chamber wall in the heart which masks cardiac rhythm problems. Angiograms test for arterial blockages.
Forum Editor, Angioplasty.Org, July 15, 2007

• My two younger brothers, ages 49 and 51 respectively have had heart attacks, the younger one just a few days ago. After the older one had his which he survived with 5 stents to deal with his 95+ blockage, I had a nuclear stress as well as a sonogram, both of which were negative conducted by my cardiologist. Now the younger one, a former world record holder in distance events just suffered his heart attack a few days ago and also survived. He would appear to be in excellent shape with daily workouts and not a likely candidate compared to me, his oldest and much heavier brother, age 53 but also a former runner. I have had no chest pain but a two instances of almost passing out that weren't fuly explained along with several of lightheadeness and just not feeling right that have lasted from several hours to a day or two during the last year. Should I seriously be thinking about a angioplasty?
Rick, Tehachapi, California, USA, July 3, 2007

• Glad to hear things went well. Sometimes (not always) our own sense of our body is one of the best tests -- your sense that something was amiss (even thought the Thallium stress test had a good result) led you, along with your cardiologist's recommendation, to the correct treatment. It's odd that there was no indication of a perfusion deficit (reduced flow) during the stress test, especially since you had a 90% blockage -- but it is possible that the blockage increased in the time since the test. Had you been having chest pain for a long time, or just the past 6-12 months? Genetics are a definitely strong factor. We know a story about twin brothers -- one died suddenly from a coronary blockage, so the twin decided to get a cath. Turned out he had a lesion (blockage) in exactly the same spot in the same artery as his less fortunate twin. As for how to monitor your future health, by all means discuss this with your cardiologist. CT scans are more readily available than cardiac MRI, but they do involve radiation exposure. And both imaging modalities are rapidly changing, getting more accurate and advanced with time. As for radiation from a multislice CT -- a 64 slice scan, especially if done in a gated fashion which can reduce radiation exposure, is not different in the amount of radiation than a Thallium stress test -- and may even be less.
Forum Editor, Angioplasty.Org, June 1, 2007

• I just thought I'd follow up on your (the Forum Editor's) response to my original post of May 24. I appreciated your discussion of testing alternatives. I decided to undergo the angiogram which I did on May 25 and which resulted in the discovery of a 90% plus blockage and placement of a 3.5 x 28mm SES stent in my LAD. I am feeling well and expect to fully recover. I am writing to flesh out some details in the hope others may benefit. My decision to undergo catheterization was affected by an episode on Thursday (5/17) including chest pain, pain in lower jaw and cheeks and lightheadedness. The episode lasted about 40 minutes. I had had somewhat similar episodes (maybe two or three a year)since 2001 but they never lasted more than 7 or 8 minutes. In addition, I had been to the ER after one such event in 2002 and again in 2006.No heart problems were discovered on either occasion. Furthermore, after the 9/2006 event I had a thallium stress test which I passed with flying colors. So, I didn't think any of the previous episodes including the one on 5/17/07 was heart related. Being in excellent condition, I continued to think--- heartburn. In fact, that same afternoon following the event I did my usual 45 minutes on the stairmaster with no discomfort. However the 5/17 symptoms were more pronounced and lasted far longer than ever before. This scared me and in conjunction with my bad family history prompted a decision to let my cardiologist "cath me up" to use his vernacular. It turned out to be a wise choice. But now, for obvious reasons, I am reluctant to rely on stress testing in the future. Do you think that I should be requesting a cardiac MRI or multislice CT scan every year or two to monitor my heart?
Richard S., North Carolina, USA, May 30, 2007

• Richard -- how to decide? That's the 64 dollar (or 64 slice) question. There are two types of diagnostic tests: visual tests that show blockages (angiogram, whether invasive or CT) and functional tests that measure blood flow quantitatively (stress tests, FFR, perfusion imaging). Current research is ongoing and soon a CT scan may be able to accurately do both types of tests. Your doctor is correct about the "gold standard", but that opinion is in flux right now. Invasive angiography has long been considered the "gold standard", but in a recent discussion we had with Dr. Harvey Hecht of Lenox Hill Heart and Vascular Institute of New York, he opined that multislice CT was really the new gold standard and actually yields more information if done correctly. (Dr. Hecht is not only an imaging expert, but began working in this field with the pioneers of angioplasty.) Most cardiologists we've spoken to feel that the clear role of multislice CT in diagnosis is for "intermediate" cases, where the results of a stress test are inconclusive and where the likelihood of coronary artery disease is not high or low. This is also currently the recommended guideline. If your likelihood is high, then you may need to get an invasive angiogram anyway -- and by doing both tests, you'll be doubling your radiation dose. Another reason for going directly to an invasive angiogram is that, if a significant blockage is found, it can be treated via stenting in the same session -- sometimes called "ad hoc angioplasty". However, some cardiologists feel that this linking of diagnosis and treatment has led to overuse of angioplasty and stenting. On the other hand, if your risk factor is intermediate, why get an invasive angiogram (which does have risks, although small in number) when a 10 minute multislice CT scan will yield the answer. One always has to ask, how will this test change my treatment? So, the best course of action is to consult with a cardiologist who can look over your history and discuss this with you, and help you make the best decision for your particular case.
Forum Editor, Angioplasty.Org, May 24, 2007

• Hi. I am a healthy 57 yr old who exercises regularly. However several males on both sides of the family died in their early 50's from heart disease. In addition, my brother ,who is a year younger, had a heart attack and Angioplasty at age 37. After I experienced chest pain my doctor recommended a catheterization, which he described as the "gold standard" for analyzing blood flow to the heart. I don't want an invasive procedure if the cardiac MRI or Multislice CT will give as good (or almost as good ) a picture of my problem. My question is--how do I choose?
Richard S., North Carolina, USA, May 24, 2007

• I had a CT scan last year and have since received 3 angiograms and 3 DES stents. My doctor wants another angiogram but I d like to consider a 64 bit scan. I also have two younger brothers both experiencing chest symptoms similar to mine. And like me, they have both been given a clean bill of health on all three types of stress tests. I'm recommending a scan of sorts as my CT scan prompted my doctor to get me in for my first angiogram where they found a 99% blockage. I would like some feedback on your experiences, results and cost.
ASF, California, USA, March 12, 2007

• Karen -- there's no question that the 64 slice CT angiogram is less invasive. An IV of contrast dye and 15 minutes later it's done -- no puncture of the femoral artery, no catheters, arterial complications, etc. It's also less expensive, but obviously not if you have to pay for it yourself. Reimbursement for Cardiac CT is a big issue right now -- especially as more and more studies are published showing its diagnostic accuracy. In your case, the big question is for your interventional cardiologist or surgeon -- and that would be whether they think they can get the information they need from the CT. As far a blockages go, the 64 slice CT has been shown to be highly accurate in excluding coronary artery disease. In other words, if the CT shows no blockage, then there probably isn't any. But there may be other things that your doctors are looking for, so this is a conversation you should have specifically with the doctor who would be doing any treatment. Normally an invasive angiogram is recommended if it is thought that treatment is likely and would be done in the same session. The radiation dose for a multislice CT is similar to that done in an invasive angiogram, although this can vary widely, depending on how the CT is done.
Forum Editor, Angioplasty.Org, March 9, 2007

• Hello, I am a 35 year old female in relatively good health. I had open heart surgery on May 8, 2006 to ligate a RCA to LV Coronary Artery Fistula which was misdiagnosed when I was a child as a heart murmur. I developed a cardiac tamponade, which required a second surgery on May 13, 2006. After being released from the hospital, I developed an infection in my incision (which was caught early and taken care of with antibiotics), I then caught pneumonia which was also treated with a course of antibiotics. My sternal incision has formed a keloid scar, for which I have received injections of kenalog to minimize the pain & itch(3 injections to date). I was recently (1/23/07) hospitalized for chest pains and had several tests. The cardiac cath done prior to CAF ligation revealed no blockages, but the tests done during the Jan 2007 hospital stay were as follows: ECG returned an inferior infarct, X-rays revealed an enlarged heart, nuclear stress test indicated probable issues with front & back of heart. The doctors also suspect that my sternum hasn't fully healed due to the rocking and crunching that happens when they palpate my chest. One of the cardiologists I saw recommended that I undergo another cardiac cath. I was hesitant due to the complications I had following the surgery. I obtained another opinion, and was advised that I could choose to have a 64 slice CTA scan performed in lieu of another cardiac cath. My quandary is that while my insurance will cover a cardiac cath, it will not cover a CTA scan. I would gladly pay for the CTA out of pocket if this will accurately diagnose what is causing the chest pains; however, if I will have to eventually undergo a cardiac cath anyway, I would rather skip the CTA even though I am hesitating to go with another invasive procedure. Any advice would be appreciated!
Karen A., Hawaii, USA, March 8, 2007

• Does anyone know the codes for insurance purposes for this procedure -- Multislice CT Angiogram -- (diagnosis code and procedure code)? I am trying to find out if my provider covers it - Highmark Blue Cross/Blue Shield. Thanks
John Burkovich, Monroeville, Pennsylvania, USA, March 7, 2007

• Eileen -- we assume you mean Calcium scores -- which are done without contrast and at a low radiation dose on either a multislice CT or an electron beam CT. They range from 0 to over 400, with zero signifying virtually no calcium deposits, and anything over 400 being high. A number of studies show a correlation between calcium scores and coronary blockages (they are not the same thing -- it is possible to have one without the other). A significant calcium score, along with an ultrasound of the carotid artery showing plaque, has been identified in the recent SHAPE guidelines, as an important indicator of coronary artery disease, one which would point to further testing, either with a full dose 64 slice CT that could show arterial blockages, or an invasive coronary angiogram, done in the cath lab.
Forum Editor, Angioplasty.Org, March 7, 2007

• I recently had a 64 slice Cardiac CT and was told I got a score of 1. What does that mean?
Eileen, New York, USA, March 6, 2007

• Patrick -- thanks for the clarification. Our Imaging and Diagnosis Center describes the various tests given cardiac patients. The nuclear stress test doesn't yield the kind of visual picture of the blockage that one would get from an angiogram of the artery. It is what's called "a functional test" -- that is, it measures the blood flow to a specific part of the heart. For example, an angiogram might show a 50% blockage, but the important question would be "is that blockage an obstructive blockage? does it actually restrict blood flow and cause ischemia to the heart?". To answer that, one needs a "perfusion study", which is what a nuclear stress test is. It measures how much blood flow is perfused through the artery to the heart muscle. If a nuclear stress test is inconclusive, then the next step is usually an angiogram. There is thought that within the near future, the nuclear stress test may be replaced by the multislice CT angiogram -- in our interview with Dr. Armin Zadeh, he discusses research now being done at Johns Hopkins that would allow the CT to be both an angiogram AND a perfusion study simultaneously: a "two-fer" in effect.

By the way, the fact that the stent in your RCA was large is good (we assume he meant wide) -- large diameter arteries definitely have lower restenosis rates. As for the fact that your insurance wouldn't cover Plavix the whole time, the recent "Joint Science Advisory", issued by all the major heart organizations, concludes with calls upon Congress and insurers to prevent just such a situation. Finally, regarding your other stents that are closed "like concrete", there are new technologies being developed to open what are called CTO's -- or chronic total occlusions. There is in fact a major meeting going on today and tomorrow in New York, called the "Chronic Total Occlusion Summit", addressing these issues. But these are complex situations and, as we always advise, your cardiologist is the one who knows your clinical status best, and also is intimately involved with what is or is not possible, or even helpful. (Just because he "can" do something, doesn't mean he "should".) What you "should" do, however, is whatever you can to reduce your risk factors, which you probably already do -- keep cholesterol and blood pressure under control, no smoking, keep as active as possible, etc.
Forum Editor, Angioplasty.Org, February 22, 2007

• Please let me clarify. After my nuclear stress test this January, I had another angiogram and had a stent placed in the RCA, which was now 90 per cent blocked. The cardiologist said it was a large stent. He told me that the first stents had completely blocked "like concrete" and they couldn't be opened. I have been on Plavix and Aspirin the whole time, except for brief periods when insurance wouldn't cover it and when I had surgery- just a few days. This procedure was earlier this month, on February 2nd. My concern is that if this new stent blocks up like the old one, I will die. If a nuclear stress test can not measure how much blockage there is, then how do I monitor the situation? Exactly what can be seen by a nuclear stress test anyway? Can't they just do an annual heart cath angiogram?
Patrick, Costa Mesa, California, USA, February 21, 2007

• When you say "the cardiologist said it couldn't be opened") was this an interventional cardiologist? We're not clear how it could be determined that you had a 100% blockage via a nuclear stress test? The stress test shows function -- it can measure ischemia -- but it doesn't visually show a blockage. One reason to have a cardiac cath or standard coronary angiogram in cases like yours is that it is possible to open up a blockage if one is found. By the way, nuclear stress tests can involve a not-insignificant amount of radiation. CT angiograms also involve radiation -- that amount is being reduced as new methods and technologies are introduced. And a CTA can show a blockage -- however, if there is evidence of blockages and restenosis (reblockage) a cardiac cath may be the best diagnostic test -- mainly because it can quickly be converted into a treatment in the same session.
Forum Editor, Angioplasty.Org, February 21, 2007

• I am a 47 year old male. I have several negative risk factors working against me. My father died at 74 of heart failure after having at least 3 heart attacks and a few open heart surgeries, starting when he was 51. I had an MI in January of 2004 and had 2 drug eluting stents placed in the LAD artery. Then, the RCA was 60 per cent blocked. I pushed for a nuclear stress test, and had one this January. My stents were 100 per cent blocked (the cardiologist said that it couldn't be opened) and the RCA was 90 per cent blocked. I was told that if it reached 100 per cent, I would die. He recommends a nuclear stress test every year. Some collateral arteries are now providing blood flow to the left side from the RCA. I have been on Plavix all the time since the first angiogram in 2004. Are there other ways of monitoring any blockage in the new stent in the RCA, my life literally depends upon it.
Patrick, Costa Mesa, California, USA, February 15, 2007

• Sharel -- chest pain is not always inidcative of coronary artery disease. And in women, chest pain is a bit more complex. Of course, your doctor is the best source of advice on any of these questions, but we would assume that since all of your mother's tests showed negative for ischemia and that she has been judged at low risk for coronary artery diease, medical management and life-style changes are the way to go (we assume she doesn't smoke, etc.). A CT Angiogram varies in cost -- you can call an imaging center to verify -- but the question is whether there is a reason to get the test (there is also a radiation dose involved). CTA is very useful and accurate in ruling out CAD in intermediate cases. But you should discuss this with your mother's cardiologist. We think he/she would agree that a standard invasive angiogram is certainly not indicated.
Forum Editor, Angioplasty.Org, February 14, 2007

• My mother (58yrs) went in to the hospital a few days ago for chest pain, and high BP. SHe had been on medication for high BP for several years. She was admitted in the hospital. Her EKG was normal at first but troponin level was high. After a few days, troponin fluctuated and EKG showed dynamic changes. Because her blood was not flowing well on collection, she was put on heparin intravenously and diagnosis was Coronary artery disease. Cholesterol is normal. After angina and burning sensation in chest subsided, her ECHO and stress test showed negative. Her diagnosis now was no ischemia or not at major risk. She has been released with aspirin, increased dose of beta blocker (atenolol) and lipitor. She was told an angiogram was unnecessary. Based on her tests. Is an angiogram advisable? What is the out of pocket cost?
Sharel, Irvine, California, USA, February 12, 2007

• David -- because everyone's clinical situation is different, we can't recommend a specific test or treatment for any patient -- that's up to your cardiologist. But you can definitely ask him/her why they recommend a standard angiogram and not a multislice CT -- they may have a very good reason and you'd be more confident if they could tell you why, in your particular case. One possible reason would be that there's a likelihood of an intervention being necessary, which can be done during a catheterization, but not during a CT angiogram, which is non-invasive and not done in a cath lab. On the other hand, state-of-the-art 64 slice CT angiograms have a very high (99+%) negative predictability -- that is, the CT is very accurate in ruling out coronary narrowing. Does this hospital have a multislice CT scanner?
Forum Editor, Angioplasty.Org, February 10, 2007

• Had an eluting stent placed in LAD 18 months ago. Had a follow up nuclear stress EKG after 6 months and was clean. Discontinued Plavix. 6 months later another nuclear stress EKG came back abnormal. Doc recommends angiogram but I'm not excited about it. Is the scan the way to go instead?
David H., Louisiana, USA, February 9, 2007

• Jeff -- Read our topic above on MSCT. Yes, there is a not-insignificant radiation dose -- depending on where and how the MSCT is done, it's about the same as a standard angiogram. Another option might be a Calcium Score CT. This is done without contrast and the radiation dose is much lower. Dr. Armin Zadeh of Johns Hopkins talks about the Calcium Scoring Exam in his interview -- scroll down about 3/4 of the way. While not as detailed as the MSCT, it can give information on risk factors. Let us know what you decide on and the outcome.
Forum Editor, Angioplasty.Org, January 28, 2007

• I am a healthy 49 year old male. Except for family history, I have a low cardiovascular risk profile (normal to low blood pressure, never a smoker, totally clean stress test, good cholesterol profile (119 LDL, 80 HDL), low trigs and CRP. However, my father had 2 heart attacks in his 50's, CHF, and died of a heart attack at 78. My 47 year old sister has a racing heart rate. My internists said if I was concerned, I could do a Coronary CTA/MSCT to learn more about my risks. Given the radiation/cancer and other risks, I wonder if I should? Your opinion?
Jeff H., Indiana, USA, January 28, 2007

• Lloyd -- an MSCT scan in not really indicated just to keep checking if a stent has occluded. If you were to have symptoms, angina, etc. that might signal a reblockage (or a new one) then it might be a way of ruling out a blockage. But there is a radiation dose delivered, so you'd want to weigh the risk/benefit ratio first. Drug-eluting stents have a restenosis (reblockage) rate of less than 10%.
Forum Editor, Angioplasty.Org, January 23, 2007

• In November of 2006 I had a Taxus Stent implanted in my LCA. Is it wise to have the Multi Slice Coronary Ct Scan to determine if the stent is occluded over a period of time?
Lloyd R Mackney III, New York, USA, January 18, 2007

• Thank You, Forum Editor. I read the articles you referenced and yes there is risk involved in Heart Cath's and in Imaging. I had a terrible experience with one of my Heart Catheterizations as they nicked an artery and I suffered an acute event a few weeks later, from this error. I guess we need to know all the facts and the patient makes an informed decision. This 4D CT scanner is suppose to be superior but it was ordered for my neck and not my heart/chest. I am due more heart testing in 2 months and am trying to lower my exposure to radiation. Thanks for this great and informative forum.
Carrie, Houston, Texas, USA, January 14, 2007

• Carrie -- we addressed some of these issues in our November 5 post below. While there isn't a hard and fast answer (due to variations in the way the CT scan is conducted) most say the 64-slice CT and the cath are relatively close in radiation. One of the interesting features of a 64-slice CT angiogram is that is also covers parts of the chest outside of the coronaries. For example, a heart scan can also reveal information about the lungs and upper chest. No information on whether you could combine the thyroid scan with the heart (a "too-fer") but if you have questions about the radiation dose, ask the provider who is doing the scan -- they would be able to tell you, based on their own technique, how the dose compares with a cath. As for weighing the risk of cancer, read our May 9 news feature, "Safety Risk of Multislice CT Angiogram Compared to Cardiac Catheterization".
Forum Editor, Angioplasty.Org, January 14, 2007

• Question: How much radiation does one get with the 64 slice CT scan? I would like to have this in lieu of another cath to see if my stents are still open. I have had 3 heart caths/angiograms in the past and know I received radiation on these. I am also scheduled to have a 4DCT scan of the neck for thyroid issues next week. Can I eventually suffer with some type of cancer from all this radiation? Has anyone been told? Thanks, Carrie
Carrie, Houston, Texas, USA, January 14, 2007

• Don -- glad the CT identified a problem -- had you been having symptoms? For the latest info on the drug-eluting stent situation, check our DES news page, and also read our "Patient Advisory on Late Stent Thrombosis".
Forum Editor, Angioplasty.Org, December 17, 2006

• I had the GE 64 slice CT That showed a 70% and 90% block. I followed that up with the cath and had two Taxus stents put in. I am now on Plavix and aspirin, I guess for the rest of my life. Had this done in Oct 2006. And now almost daily I read articles on the dangers of coated stents. What gives? By the way I just can't believe the hospital cost for the procedure and stents > $39,000. WOW.
Don, New York, USA, December 11, 2006

• A in California -- contrast media have advanced a lot over the past three decades, but they are, for the most part, still iodine-based and some people do have allergic reactions. Make sure to discuss this with your cardiologist prior to the CT or cath. There are techniques for minimizing some of these reactions.
Forum Editor, Angioplasty.Org, November 19, 2006

• I had an IVP over 30 years ago, and became nauseous from the iodine contrast. If I have a CT or cath angiogram, can this be prevented?
A, California, USA, November 16, 2006

• Kalip -- while most Multislice CT angiograms don't visualize inside of a stent that well, a CT done with contrast can show if the blood flow through the stent is reduced. If you are thinking of getting one, make sure to ask the operator these questions BEFORE. Not all multislice studies are the same.
Forum Editor, Angioplasty.Org, November 8, 2006

• I had two cypher stents implanted in my LAD two years ago I am wondering if a Multislice or Multidetector 64 Slice CT Angiogram would detect any restenosis.
Kalip, Florida, USA, November 5, 2006

• Radiation dose with Multislice CT is varies quite a bit, depending on the system being used, and the specific way in which the test is conducted. Many CTs are now done with a "gated" system, where the X-radiation is only emitted during a specific phase of the heartbeat. This can reduce radiation overall very significantly. Several studies show the radiation dose between 64 slice CT and standard catheterization to be roughly equivalent in these cases. The reason your doctor might lean towards the cath is that he/she feels the liklihood of coronary blockage is higher, and that you'd ultimately have to get a cath anyway (thus doubling the dose). However, the amount of radiation from the nuclear scan you already have had is probably larger than either a 64 slice CT or a cath.
Forum Editor, Angioplasty.Org, November 5, 2006

• I have had an abnormal nuclear scan with an area of ischemia. My doctor does not want to do the cardiac CT because of the radiation risk, as I have been treated for breast cancer. Instead he prefers to do a cardiac cath to assess for blockages. I have had absolutely no cardiac symptoms and would prefer the cardiac CT. Is there concern for breast cancer survivors with the high amount of radiation involved?
Linda T, Texas, USA, November 5, 2006

• I had a 95% blockage of the RCA 8 years ago. I had angioplasty and a stent. About 5 months ago I had a successful stress test. This week I had symptoms of angina similar to that of 8 years ago, but not as strong and not lasting long. I went to the ER and all tests were good. Can angina re-occur after stenting with symptoms being similar to those prior to stenting? What tests would show blockages without going through another angiogram?
Ellen Z., New York, USA, November 3, 2006

• Hi! I am 32 year old male. Suddenly, My father passed away due to heart attack at the age of 60. I was facing psychological problem then, I have taken stress test which is negative and I have taken 64 slice CT Scan which is negative and my doctor was wondered why I was stressing him for a 64 slice CT scan!. Now, My question is 64 slice CT being negative, How long I Need not worry about my heart?
Shiva, November 3, 2006

• hi my husband had stent put in 2 years ago. Recently he had 64 slice ct done. The results shows he has 1300 calcium score. Do we need to do any further test.
L., Louisiana, USA, October 8, 2006

• Dear Forum Editor, thank you for the fast reply. Now I understand my mom's case could be restenosis or another clogged artery, as I believe her doctor suspects. She doesn't experience any chest pain so that is a relief. She will do a catheterization next week and her cardiologist promised her to re-open the artery in the same session just as you said. Thanks again and I will keep everyone posted on her condition. Thanks for the great work you are doing in helping all of us patient concerned folks.
Rima, Lebanon, October 6, 2006

• Rima, you posted to a different topic about the thrombosis and, as we said there, thrombosis is an acute event -- it happens quickly, completely blocks the blood flow and must be treated as an emergency situation. You may mean "restenosis" which is a different process whereby the blockage comes back slowly. By the way, does your mother have any chest pains? As for the iodine-based dye, called "contrast", the dye used in standard catheter-based angiograms is also iodine-based. If you're allergic to one, you will be to the other. However, it seems that your mom's cardiologist has a pretty strong suspicion that there may be a blockage, in which case if she has a catheterization in the cath lab and he finds one, he can treat it and re-open the artery in the same session (not possible when doing a CT angiogram).
Forum Editor, Angioplasty.Org, October 5, 2006

• Hi. My mom had a Cypher Stent placed in her main artery about a year ago. She recently failed a stress test and the Cardiologist asked her to do an angiogram to see if the stent has late thrombosis or another artery has been clogged. She wanted to do a CT scan but her Dr. absolutely insisted that she not do it. He explained that first the Iodine solution used could affect her stent and that if there is a clogged artery the CT scan could put her health at risk. First of all, thanks for answering all those questions. Now I can tell her to go through with the angiogram / angioplasty.
Rima, Lebanon, October 4, 2006

• While the questions are flying in fast so are your answers which is a great comfort to us all!!...by the way in my previous post where I asked if a CT scan would be of any value after an Angiogram and Thallium follow up I neglected to say that I did have stents placed about 14 months ago (4 in the LAD to cover 3 blockages).
Rick, New York, USA, September 29, 2006

• The questions are flying in faster than we can answer them! But we'll try.

K. in India -- both CT scanning and standard angiography can be done safely on elderly patients. Which you should do is really something your cardiologist can help you with -- it's all about what you are looking for. Be sure to ask your cardiologist why they are recommending one test over another.

Rick -- you've had a fair amount of testing and if they have been negative, as opposed to "intermediate", then you probably do not have coronary artery disease. The CT angiogram is probably not going to add information, and it does carry a radiation exposure.

Rodney from Australia -- what clinical trial are you in? Multiple CT angiograms in a short time adds to your radiation burden -- a multislice CT angiogram is at least as much or slightly more radiation than a standard angiogram, and many times more than a simple chest X-ray. Are these CT scans mandated by the trial? Let us know some more info on this.

Al in Nevada -- you are correct. If an angiogram reveals a blockage, it could be opened during the same procedure with a balloon and then usually a stent to hold it open. If bypass surgery is recommended instead, that would be a scheduled procedure (done in an operating room, not an angiogram suite, a.k.a. a catheterization lab). With Multislice CT, a corrective procedure cannot be done, because the CT scan is done non-invasively -- even can be done in the doctor's office -- and it only takes a few minutes.

Finally D.H. in New York -- first of all, nothing said here should override anything you've been told by your doctor. You might want to ask him/her this question, but the reason for the treadmill test is that it is a functional test. It's one thing to look at an angiogram or CT scan and see a blockage. It's another thing to measure whether that "blockage" is actually causing a problem. Functional tests measure the actual amount of oxygen being delivered, not just the visual "picture".
Forum Editor, Angioplasty.Org, September 28, 2006

• I am 14 months post cardiac cath with 2 cypher stents in branches of the circumflex artery. At the time that was done they told me that in another 12 months or so to have another nuclear scan and treadmill test. However since that time the hospital has acquired a 64 slice CT scanner. I am wondering now which one would be the more accurate for the follow up evaluation?
D.H., New York, USA, September 26, 2006

• I am on a clinical trial for coronary plaque removal supervised by my physician. I have had two 64 CT Spiral Angiograms done to check progress with a 6 month interval. The Radiologist has just refused to conduct a further CT Angiogram because he is concerned about the X-ray radiation danger. Is his concern justified? I can easily use another Hospital. I have had around 6 chest X-rays throughout my life - 10 overall
Rodney Whitworth, Belgrave, Victoria, Australia , September 26, 2006

• If you have had an angiogram say 9 months ago and a thallium stress test 3 months ago, both of which were negative, but are still feeling upper chest discomfort is it a waste of time to have the CT scan?
Rick, New York, USA, September 25, 2006

• Would appreciate your view on a tragic case involving my wife of 36yrs age. Having attended the A&E department with sever abdominal pains, my wife was admitted into hospital. Over the next 8 days doctors could still not diagnose the problem. An emergency operation was performed where it was found that she had suffered a Mesenteric vein thrombosis. Consequently she had a 1.5 meter section of small bowel removed and was then admitted to ICU. She contracted VRE while in ICU (a patient two beds from her had this bug) and eventually suffered multiple organ failure and passed away. Question; After being admitted and the failure to diagnose, can you tell me when it should have been appropriate to carry out a CT scan or Angiogram? Kind regards Mike
Michael Horne, Bedfordshire, England, September 19, 2006

• I am 84 year old. I do not experience any pain. After a recent Thallium stress test, cardiologist recommends an angiogram. I am reading articles re less invasive I am told that if an angiogram reveals the need for a stent, or even by-pass surgery, it could be performed then and there. That seem not to be the case with less invasive MultiSlice CT imaging. Please explain the pros and cons. Thank you.
Al, Nevada, USA, September 17, 2006

• my father is 77 year old recently he had mild heart attack doctor adviced him to do angiogram. is it safe to do angiogram for 77 year old man. he is not diabetic
K., India, September 17, 2006

• Try to help with some quick answers. M.C. in Illinois -- some patients like yourself are allergic to iodine-based contrast dyes. There are a few ways to reduce this reaction, if an angiogram has to be done (and standard angiograms done in the cath lab use the same type of contrast dye as multislice CT scans). Prednisone pre-treatment as has been recommended is one thing -- also benadryl during the procedure itself. Diluting the contrast is also done, but this affects image quality. Depending on the weight of the patient, a diluted solution may not allow sufficient image quality. Tell your cardiologist your concerns. The smoother the procedure goes, the more successful the outcome. And G., from California, yes -- all imaging is a problem with heavy patients, CT, MRI as well as standard catheterization. CT angiography is quite accurate, especially as a negative predictor -- if it shows no blockage, there probably isn't one. In your case, the CT did show a blockage, but couldn't quantify (or measure) it precisely. Paul -- there's no problem getting a CT if you have a pacemaker -- unlike an MRI, there is no magnetic field with a CT -- it uses X-ray radiation to image. However, the metal in the pacemaker might cause artifacts which could interfere with imaging details that are near the pacemaker -- this may not be a problem for imaging your coronaries.
Forum Editor, Angioplasty.Org, September 17, 2006

• I am a 36 year old male and a a 64 slice CT that showed blockage that "definitely did not exceed 50%". My cardiologist was not comfortable so he ordered an angiogram. It turned out that I was 80% blocked LAD and needed a stent. When I showed the video to the CT doctors, they said they couldn't pick it up because I am overweight.
G., California, USA, September 17, 2006

• Can you have a multislice ct angiogram, if you have a pacemaker?
Paul H., Texas U.S.A., September 16, 2006

• I am scheduled to have a ct angiogram and I am highly allergic to the dye that is used should I be afraid? I know that they will give a pre treatment of prednisone but can that safely assure me that nothing will go wrong?
M.C., Illinois, USA, September 6, 2006

• The question of whether a 64 slice CT scan is as good as a standard angiogram is THE question these days. And the answer is: it depends on each patient and what you're looking for. Vicki -- you've been diagnosed with ischemia. We assume your tests indicate a high probability of a coronary blockage (but please ask your doctors to verify this). If your tests show that a blockage is pretty certain, then there's no reason to do a multislice CT scan. You'll expose yourself to as much (or more) radiation as a standard angiogram, and you have to go for the angiogram/angioplasty anyway. The CT is a great option for patients with "intermediate risk" -- the test is highly accurate for negative results -- if the CT says you don't have a blockage, you can believe it (statistics show that 30% of all diagnostic catheterizations show no disease, so these people would have benefited from a CT instead).

As for some other patients' questions, CT is not able to accurately visualize the interior of stents -- too many artifacts from the metal. Angiograms are the best option, especially because if a problem is found, it can be dealt with in the same procedure. Likewise, potential thrombus cannot be accurately visualized on a CT. In fact, it is almost impossible to know where a thrombus might occur. There is research ongoing with intravascular ultrasound, but that is an invasive catheter-based procedure that might typically be done during a stent placement.
Forum Editor, Angioplasty.Org, September 3, 2006

• Hi, I have been diagnosed with induced ischemia in my TMT. So the docs have suggested angiography, and if found 70%+ blockage, they will proceed with stent angioplasty, then and there. Lot of people are suggesting that I first do 64 slice CT before I do the angiography. Docs.have suggested angiography directly, and then depending on situation to do angioplasty. What do I do ? Should I do 64 slice CT, and then go to the doc.with the results? I have no regular problem and am normal otherwise, with no pain or irritation. Please suggest.
Vicky, India, September 3, 2006

• i am M/41/1.76 meters/68Kg. Had a good experience of physical activities. Daily runs for about 4 to 6 x400meters along with all physical stretch exercises. No known history of heart ailments in the family. Suddenly had type III 100% Ostial LAD thrombotic occlusion. in LAD. underwent cag + primary PTCA+ stent(3.5mmx16mm Yukon DES) to LAD on 18.08.2006 with mechanical thrombus Aspiration (Export 6F). Though feels now normal on medication with Ecosprin 150mg,Plavix75mg, Fovas 2.5mgetc.. But can this sudden thrombus occlusions can re appear/reoccur ? if so what would be the chances?? Can MSCT help me in assessing with out timely?
CVK, India, August 28, 2006

• Please let me know whether a person who had undergone a bypass surgery and having inserted 3 stents could check whether he has any more blockages in the same vessels or any other vessels by this CT angiogram.
CHARMAN, Hong Kong, August 24, 2006

• I am a 58 year old physician who just became a patient (very scary!) A year ago I had an episode of sinus tachycardia that was unexplained. I then had 2 stress echos and was told they were "normal", although on the 2nd one I had some brief ventricular tachycardia and some PVCs. I worked hard outside and had no chest pain. I changed employment and finally followed up with a new cardiologist in the new network. He suggested the 64-channel VCT, which found a severe stenosis in the LAD. This quickly led to a TAXUS drug-eluting stent 5 days ago. I am doing well so far with the aspirin and Plavix necessitated by using this stent. I think I owe my life to divine guidance to that VCT scanner! It wasn't around here a year ago when I had my first symptoms, and they apparently didn't think I needed a cath at that time. Also thanks for the forum with all the Plavix/ASA posts. I've had a lot of questions about that - kinda scary, but I guess it's an adventure I'm now on. John (MD), Shelbyville, Indiana (near Indianapolis) -- [Editor's Note: "VCT scan" is a brand-name for GE's 64-slice CT scanner -- 64-slice scanners are also made by Toshiba, Philips and Siemens.]
John Fleming MD, Community Health Network, Indianapolis, Indiana, USA, August 9, 2006

• My husband had a CT scan of his kidney and it showed a blockage in the artery leading to the right kidney. When he went for the angioplasty the Surgeon looked at the CT scan results before the procedure and he came back and told us that there is a possibility that they might not find a blockage. And after the procedure was done he came and told us that there was no blockage but he did check both sides ahile he was in there. Why would the CT scan show that there was a blockage if there wasn't? I feel that this procedure possibly wasn't necessary. Isn't there a more accurate test to show that there is actually a blockage before a person has to go through a procedure to find out there really wasn't. Granted it is peace of mind. But, considering the risks involved there should be a more accurate test to be done?
Debbie T., Wisconsin, USA, August 9, 2006

• Joan -- an angiogram is sometimes a still image, usually in radiology. "Dynamic" implies that the angiogram is showing movement over time, which is the normal type angiogram done in coronary and most other interventional procedures -- sometimes called fluoroscopy. The physician gets to see not only the blockage itself, but the flow of blood in and out of the arterial segments, which is critical in assessing the status of the occlusion.
Forum Editor, Angioplasty.Org, August 9, 2006

• Am reading an article that refers to "dynamic angiogram". Can you explain what that is?
Joan R Rose, Medical Economic Magazine, Goodyear, Arizona, USA, August 8, 2006

• Su -- we can't advocate or give medical advice -- only your doctor can. But we can call your attention to two articles on Angioplasty.Org that may give you more specifics. One is our interview with Dr. Daniel Berman; the other is our feature, Will Multislice CT Angiography Replace Cardiac Catheterization as a Diagnostic Tool? The basic thrust is that for "intermediate patients", the 64-slice CT scan seems to be a good option -- but if the diagnosis so far leads your cardiologist to believe that you may have obstructive coronary artery disease (blockages that are reducing blood flow to your heart muscle) and that it is likely to need an intervention, such as an angioplasty or stent, then it probably makes more sense to go directly to the cath lab. By the way, the radiation dose is roughly the same for a coronary angiogram or a 64-slice CT.
Forum Editor, Angioplasty.Org, August 4, 2006

• I am almost 60 yrs old woman, who was just told my stress test was abnormal - i.e. EKG is abnormal, heart was slightly enlarged and photos before and after the test show some blood flow problem. I am in dilemma whether to stick to normal catheterization or go with new CTA procedure, since doctors themselves are not sure about one test over other. I am also concern with the extra radiation exposure. I have no symptoms, neither do I have any family history of heart problems. Confused about which test to take. Any suggestions?
Su, New Jersey, USA, August 3, 2006

• K., an abdominal angiogram with runoff (sometimes spelled "run off") visualizes the lower torso, lower abdominal aorta (main blood vessel) and the arteries in the legs, mainly to see if and where there may be blockages that would explain slower blood flow in one or both legs. This procedure has traditionally been done as a standard angiogram, but those centers that are trained and equipped with Multislice CT equipment have had excellent results doing the procedure with CT technology. One advantage to CT is that once the 3D image is constructed, the anatomical view can be manipulated wihtin the computer and the arteries looked at from an infinite number of angles, not just the one used to acquire the image.
Forum Editor, Angioplasty.Org, August 3, 2006

• Please explain an abdominal angiogram with runoff. What can we expect from this procedure? There if question as to the pulse in my husband's left leg being not as strong as the right. Any information would be helful. Thank you.
K., Illinois, USA, August 2, 2006

• Marilyn -- see the various articles referenced in other posts about the differences between a standard angiogram and a 64-slice. The reason to do the standard one is if there's a good reason to think an intervention (angioplasty or stent) might be done at the same time (angioplasty or stenting can only be done in the cath lab, not with CT equipment). For intermediate risk patients, where only the diagnosis is the concern, not the treatment, the multislice CT is becoming more and more the imaging procedure of choice. You, of course, have to find a hospital or group that does 64 slice CT and make sure your insurance will reimburse for it.
Forum Editor, Angioplasty.Org, August 2, 2006

• My mother is scheduled for an angiogram on Friday in Peoria. (OSF) One of her friends had the 64 Slice procedure done instead of the regular angiogram. Is there a specific group who does this, or can any cardiologist do this instead of the older angiogram procedure? Also, she is only interested in the cardio portion ("At 77, I really don't want to open up a can of worms with diagnostics of my entire chest, just the heart"). Is it possible to do cardio only? Please let us know ASAP. Thanks!
Marilyn Oehler, Davenport, Iowa, USA, July 31, 2006

• Donald -- you certainly can visualize stents with 64 slice CT -- the questions would be why would you want to? The choice of which test to take depends on what you're looking for. A stress test (nuclear or ultrasound) is a functional test -- rather than visualizing any blockage, it can tell whether that blockage is actually affecting the blood flow and causing ischemia. Usually. Sometimes it's inconclusive which is why other tests may be needed. If there is concern you're stents have gotten blocked up, then you may well need an angioplasty/stent to re-open that area -- this must be done in a cath lab setting, so it usually makes more sense to do the visualizing and treatment in the same session.
Forum Editor, Angioplasty.Org, July 31, 2006

• When a patient already has 2 cypher stents in their coronary arteries, can you have an exam with the 64 slice CT scanner for futher evaluation at a later date or do you have to have the treadmill stress test and nuclear scan for evaluation. I thought that I had read someplace that you can't have the 64 slice CT scanner done if you already had stents.
Donald H., Illinois, USA, July 30, 2006

• California J. -- We suggest that you read our recently posted interview with Dr. Daniel Berman, who is the Director of Cardiac Imaging at Cedars-Sinai in Los Angeles. He states:

"The diagnostic coronary angiogram isn’t really a very common test anymore. I’ll bet if we were to survey the number of coronary angiographies done in the United States today that are done just for the purposes of establishing a diagnosis, with no intention of doing angioplasty, it would be a very small number.... In the intermediate likelihood range, we use the test with the highest sensitivity and specificity for detecting obstructive disease -- and that test is the CT coronary angiogram."

We're not saying you should have a 64 slice CT scan instead of an angiogram, but we are suggesting that you ask your doctor why he is recommending one over the other.
Forum Editor, Angioplasty.Org, July 20, 2006

• Hello, I am 40 and occasionally have weird feelings where my heart is and sometimes on my left arm. My type II diabetes is in great control, I suffered (unknowingly) for 20 years with acute sleep apnea and got it fixed when I was 30 and I'm 70 pounds overweight. I had a positive MYO-View two days ago and was told today by the cardiologist that even though he thinks the test was a false positive, he wants me to have an angiogram next week. He never mentioned a 64-slice CT scan. Has anyone had the angiogram and wished they had the CT scan?
J., California, USA, July 19, 2006

• Thomas -- insurance coverage is something you'd have to check with your specific plan. Many currently do not cover multislice CT angiograms in certain situations -- that will likely change in the future
Forum Editor, Angioplasty.Org, July 18, 2006

• Which types of non-invasive angiograms are/are not covered by Medicare?
Thomas H. Teglassy, Baltimore, Maryland, USA, July 17, 2006

• Bob -- thanks for the article link and your posting. It's impossible to get into the question of whether or not a given test is necessary for a given patient without actually being your physician -- we can say that the amount of radiation from a 64 slice CT angiogram is as not small as, for instance, a chest X-ray is. Depending on the way it's done, it can be the same as a catheterization, possibly 2 or 3 times as much -- other scans have varying amounts of radiation. Ultrasound, MRIs and ECGs don't use x-radiation at all. We're not clear if your emergency angioplasty with stent was done to treat an acute MI (heart attack) that you presented with (that's what emergency angioplasty usually means). If so, and the fact that you already have a stent and are having symptoms that aren't explained with these other tests, the only way to accurately see if your coronary arteries are involved, or if the stent is closing up, is probably the "gold standard" of a coronary arteriogram (a.k.a. catheterization). You should definitely ask your cardiologist to explain why he/she thinks it's necessary, so you can be clear for yourself that it's not a meaningless procedure. Let us know how you make out. And, if you haven't already, check out our Imaging and Diagnosis Section.
Forum Editor, Angioplasty.Org, July 6, 2006

• Had an emergency Angioplasty procedure with bare metal stent, two months ago. Since then been back to the hospital 3X with muscle pain and dizziness symptoms, but all tests shows no sign of a heart attack. Doc lowered Cardio drugs doses such as Lipitor and removed the beta blocker. Feeling ok now. The total number of tests during this time was 7 Chest X-rays, 3 CT Chest scan, 2 CT head scan with ink, and many ECG's, and Ultrasounds. Cardio Doc said things looked ok, but still schedule another catheterization in two weeks! Neuro Doc made a comment to Cardio Doc saying that those head CT weren't necessary. Now I'm questioning if the catheterization is needed... especially after reading this news yesterday http://www.canada.com/topics/bodyandhealth/story.html?id=71af50b0-7e55-4172-b40e-423fbbc11394&k=3863. Just too much to handle.
Bob, Ontario, CANADA, July 6, 2006

• I have an abnormal ECG and the cardiologist said it was inferior infarct. I did CT Angiogram and the results are no blockage of coronary artery, only mild atherosclerosis. I don't have any cardiac symptoms, blood pressure is normal. Do I need to have a cardiac catheterization to see what is the problems of abnormal ECG ?
W., Jakarta, Indonesia, June 16, 2006

• The issue of CT versus diagnostic cath has been getting a lot of attention lately. We have summarized SCAI's involvement at http://www.scai.org/drlt1.aspx?PAGE_ID=4332 and have included some good links as well.
Wayne Powell, Society for Cardiovascular Angiography and Interventions (SCAI), Bethesda, Maryland, USA, June 15, 2006

• Dear Dana -- I have just had my second angioplasty on June 1/06. I was completely amazed that you are awake on the operating table as they repair your heart -- they have to go through your femoral artery in your groin. The nurses prep you and they freeze your groin. Plus they will give something to help calm you if you are anxious, also if you think you need something more, you can have another relaxer. It does not take very long and you get to go home in 24 hours. And best of all you will feel so much better. These Drs. are very good at what they do so relax and it will be over before you know it. My thoughts and prayers are with you and god bless Dana please. YOURS BERTIE XO
Roberta Thompson, Retired, Thunder Bay, Ontario, CANADA, June 12, 2006

• My husband had bypass surgery 14 years ago He has always had his yearly thallium stress tests but now has developed a problem with his hip joint and is unable to walk on the treadmill A heart doc told him to have 64 multi slice ct. Is this his only choice or should some thing else If any one could help it will be appreciated.Thanks.
N., New Jersey, USA, June 8, 2006

• Gerard -- the arteries that supply blood to your intestines are called the "mesenteric" arteries. Ischemia is caused by lack of blood flow. This can be very serious and rapid early diagnosis is important. Multislice (or multidetector) Computed Tomography (a.k.a. MSCT, MDCT or CTA) is definitely an accepted tool for non-invasive diagnosis of mesenteric ischemia. At last year's meeting of the Radiological Society of North America (RSNA) a presentation was made by an Egyptian hospital group that concluded: "Biphasic CT scan with mesenteric CTA should be performed, as the first imaging modality, for all patients with suspected acute mesenteric ischemia.". As in heart disease, if you are considered as having a high likelihood of arterial narrowing that might require a balloon angioplasty and/or stent, then you might go right to the standard angiogram, during which the actual angioplasty treatment can be performed. But, more and more, non-invasive Multslice CT Angiography is being used for initial diagnosis -- it's faster, cheaper, and doesn't carry with it any of the potential complications of catheter-based angiography, even though those are small in number. This is not the same as a standard CT scan -- it's a multlslice CT scan, usually 16 or the newer 64 slice. Of course, any clinical decisions like this can't be made "off the web", but need to be done by your doctor, and he/she may have specific reasons for recommending one test over another. Just make sure you understand the "why". Good luck and let us know how you fare.
Forum Editor, Angioplasty.Org, June 6, 2006

• I am told i need an angiogram to look at the blood supply around my large intestine as it became ischemic during an Ironman distance Triathlon. Can i have a CT Scan instead
Gerard Santamaria, Cyclotek (Aust), Melbourne Australia, June 6, 2006

• Nancy -- The measured accuracy of Multislice CT angiograms is very good. Most studies have shown a "negative predictive value" in the high 90% range -- that means that typically only a few percent of patients with disease are not sufficiently detected. Your cardiologist is the person to ask about the interpretation of your specific results. For example, do you have symptoms, angina, etc.? Normally, treatment, such as angioplasty, is not done with blockages < 70%.
Forum Editor, Angioplasty.Org, June 5, 2006

• I have recently had a CT Angiogram that showed 25-50% blockage in two arteries. Does anyone know the accuracy of the readings?
Nancy S., Kentucky, USA, June 3, 2006

• Dana, I can certainly understand why you think it's too early, but it is! Of course, you read of very young athletes collapsing with heart ailments, as well, and babies, but you never think it's going to happen to you. I have a blockage of the left anterior descending artery. My doc says it's not a main artery, but any artery that's blocked is not an exciting prospect for me. Both of my uncles passed in their early 50's of arterial disease (blowouts) and my Dad was miraculously saved by having surgery after his aortic aneurysm, also in his 50's. I am now 53. I have 7 beautiful young grandchildren for whom I would like to stick around to see them get married. My doc (and I really do like him a lot) says his oldest patient with heart disease was 27 years old! The good side to this is that now with meds and surgery, heart disease is not the death sentence that it used to be! It is one of the most treatable disease, as long as it's identified early. I think we can both say that to have found it early was a Godsend! Good luck with your treatment plan. I know I feel worlds better now that I'm taking 100 mg Toprol XL and walking at least 50 minutes a day to keep fit. It took a while to get to this point though, I guess it was a month before I felt more myself. Again, all my best!
Theresa, Hackettstown, New Jersey, USA, June 3, 2006

• Just wanted to alert our readers that Angioplasty.Org has created a new section dealing with the various imaging tests for coronary artery disease, covering angiograms, ultrasound, multislice CT and more
Forum Editor, Angioplasty.Org, May 11, 2006

• Hi! Just found out today that I will have an angioplasty performed due to abnormal thalium and CTA results. They both show a 70+% blockage in the RCA. I am a 36 year old female, with a history of heart disease in my family, and symptoms of shortness of breath (SOB) and chest pain. It seems so early...can anyone relate? Thanks for listening!
Dana Shanks, Wichita, Kansas, USA, May 2, 2006

• After a failed quadruple bypass (three of four bypasses occluded completely within one month) my mother underwent "advanced high risk angioplasty" where several drug eluting stents were placed, including a very tricky spot in her LAD. Now seven months out, her cardiologist is pushing her to have another cardiac cath., maintaining that if there is a problem with the LAD stent she will experience a massive, fatal heart attack. However, due to the placement of the stent, other consulting cardiologists have said the cath. would be too risky for her. Aren't there new less invasive procedures that can visualize the stents? Please advise! We are in a real quandry how to proceed.
K., USA, February 11, 2006

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