An important part of wellness care is learning your options for screening for underlying pathology or maybe just understanding your baseline. Today I was reading about gathering an MRI or CT scan for measuring the kidneys, as they become less efficient as they enlarge, which may be a more timely evaluation than waiting for labs to decline. Mammograms and colonoscopies are part of these screenings, and even CT scans for long-term smokers. I am often asking clients, "How is this knowledge going to change your management?" Maybe it won't. Maybe it will be motivating and inspire lifestyle changes that ultimately improve your health. Maybe it will help us understanding your progressing health as you age. Either way, knowledge is empowering, so I thought I would share a bit about the heart scan. Is it appropriate for you?
The heart scan, otherwise known as a coronary calcium scan, is a specialized X-ray test that provides pictures of your heart which can help detect and measure calcium-containing plagues in your arteries. Calcium plagues can restrict the blood flow into the muscle of the heart so having awareness of their presence and significance can help us better understand your overall heart health. Not always are symptoms present when one suffers coronary artery disease, until there is significant dis-ease. If known, lifestyle modifications and even medication can help reduce your risk of heart attack or other heart problems.
Am I a Good Candidate?
These scans do require exposure to radiation, so they aren't right for everyone and are not currently recommended as part of a routine wellness exam. According to the American College of Cardiology and the American Heart Association guidelines, a heart scan may not be recommended for the following people:
men under the age of 40 years and women under the age of 50, because it is unlikely that calcium will be detected in these younger ages;
people who have a very low risk, because detectable calcium is very unlikely if you don't have a family history of heart attacks at an early age;
people who already have a known high risk (especially heavy smokers or those with diabetes or very high cholesterol), because they heart scan will likely not provide any additional information to guide treatment;
people with symptoms or a diagnosis of coronary artery disease, because the procedure won't help doctors better understand the disease progression or risk; and
people who already had an abnormal coronary calcium heart scan.
Having said that, the level of radiation one is exposed to with this heart scan is comparable to the amount of radiation one is naturally exposed to during their daily life in about a year's time. There are clinics which advertise heart scans to the community. These do not require a doctor's order. Alone though, these aren't overly helpful. The radiation exposure without the additional evaluation of health and a clinician's oversight, is likely not going to offer sufficient information to justify the radiation exposure.
How is the Test Performed?
Sensors are attached to your chest, which connect to an electrocardiogram (ECG or EKG), which records your heart activity during the exam and coordinates the timing of X-ray pictures between heartbeats, when the heart muscles are relaxed. You'll be placed on your back, on a moveable table, which slides into the tubeline CT scanner. Your head will remain outside the scanner the entire time and intentionally, the rooms remain cool. Some individuals are provided a medication to help slow their heart so images can be made more clear. If you are anxious, you might also be offered a medication to help you remain calm.
As the pictures are being taken, the technician may ask you to hold your breath for a few seconds at a time. The technician, of course, will operate the scanner from another room but will be able to see and talk to you the entire time. The entire procedure lasts about 10 to 15 minutes. There are no other special precautions. You'll be able to continue with your daily activities immediately after scanning.
The results will then be scored (sometimes called a calcium score and sometimes called an Agatston score) and provided to you and/or your clinician. A score of zero means no calcium in the heart. When calcium is present, the higher the score, the higher the risk of heart disease. When the score is 100 to 300 there are moderate plaque deposits, which is significant for a high risk of heart attack or other heart disease over the next three to five years. A score greater than 300 is a sign of very high to severe disease and heart attack risk. You may also receive a percentage score, which indicates your amount of calcium compared to people of the same age and sex.
If you'd like to meet with me to discuss the appropriateness of this test, I'd love to hear from ya!