In a previous post, I discussed how cardiologists are able to detect blockages before symptoms appear and the impact that is having on the treatment of silent killers such as sudden cardiac death (SCD). But one revolutionary type of imaging is dwarfing all other efforts.
Coronary calcium scan (CCS) is the mammogram of heart disease. It shows the greatest promise in helping patients who are at moderate risk for developing heart disease. CCS works by detecting calcification in the arteries which appear years earlier than symptoms.
The test consists of scanning the heart with two machines, the multidetector computed tomography (MDCT) and the electron beam computed tomography (EBCT). The procedure is non-invasive and takes place in a CT machine. A continuous EKG is performed so that images can be taken when the heart is at rest. This improves the quality of the images. If a patient is tachycardic, IV medication is given to slow the patient’s heart rate. The scans generally take only 10 minutes to complete.
The films are studied by a cardiologist who assigns a score. The calcium score, also called an Agatston score is based on the amount of calcium found in the coronary arteries. Each major artery is scored and then a total score is calculated. The test is negative if there is no calcification found. This indicates that the patient is at very low risk of having a coronary event in the next 2-5 years. If the patient has a positive test with calcification found, the score is used to create a risk outlook. This combined with factors such as family history and traditional risk factor assessment assists cardiologists in determining whether a patient should undergo further testing, make lifestyle changes, or be placed on a preventative medication regimen.
The improved prognostic acumen made possible by CCS has exciting implications. It makes possible the treatment of heart disease in young, asymptomatic men, and others with a higher associated risk of sudden cardiac death.
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