Cardiovascular test results (CT scan)


Q: I have recently done a CT of the heart with attention to the coronary arteries. The test was performed by a Siemens HeartView CT. The total number of coronary calcifications has shown as 1653.0. The report also suggests that a calcium score of 401 and above is classified as Significant Calcification.

Here are my questions:
1) Could this be an error of the machine? Could this just be one bogus number? (Given the fact that 401 is already considered significant)
2) Is it even possible for someone like me (no previous or family history of heart disease, no presence of high cholestorel) to have such high number of coronary calcifications?
3) I have appointment with the ordering physician next week, what should I ask for? Maybe repeating the test?
4) What are the possible next steps that my PCP might offer and how should I react to them? (e.g. another test that is more invasive in nature, an invasive type of treatment)
5) How is such a high score of calcifications usually being treated?

Symptoms:  N/A

A:   Hello. Welcome to Ask The Doctor. We are here to help you.

Coronary Artery Calcium (CAC) score of more then 400 is considered high risk for cardiovascular diseases. We need to interpret the scores with the age, sex and clinical symptoms on which CT scoring was advised.

Following are your answers:
1. Machine error can be there but it's not very uncommon to find such a high number.
2. Yes it is possible. Family history of heart disease is an independent risk factor for coronary artery diseases but it's not a compulsory factor. Can't comment further as you have not mentioned your age, symptoms, associated Diabetes, Hypertension.
3. You should go for a Stress test. A thallium scan would be the best option for you.
4 & 5. If your thallium scan and stress test are also evident of coronary artery disease , your doctor would refer you to a cardiologist for coronary invasive angiogram with angioplasty as per angiogram. You would be treated with anti platelets , statins. You would require a strict control of any co morbid condition like Diabetes, Hypertension if any.

You should take it in a positive way that you have come to know about your cardiac status before any devastating complication that could have arised.
I hope it helps you.
If you have any further query, please ask me.
Stay Healthy.

Comments / Follow Ups

Patient: Thanks for your reply. I am attaching the report FYI. If you have any further comments, please let me know.
Doctor: Hi. As per this report you would require a coronary angiography with angioplasty.
Good luck.
Patient: one last question: I saw my PCP today and she referred me to a cardiologist. She said coronary angiography will be absolutely necessary. I wanted to know what is the difference between the Calcium Score Test and the coronary angiography. Angiography is going to tell the calcium quantity as far as I understand, but we already know it thanks to this test. So what extra information is the angiography gonna give us? Thanks!
Doctor: Hi, Coronary angiography, is the direct visualization of the arterial lumen by flow of a contrast. It gives you clear idea, whether there is an luminal stenosis due to blockage. This is an invasive process and can be accompanied by stent insertion in the same sitting if required.
While calcium scoring is indirect way of measuring the blockage in the arteries by mean of seeing the calcification inside. That is a non invasive process.
Good Luck.

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