Coronary Artery Calcium Scoring

• What is Coronary Artery Calcium (CAC) Scoring?
• Who Should Have CAC Scoring?
• How is the Procedure Performed?
• What Do the Results Mean?
• Will the Exam be Covered by Insurance?

Coronary CT Angiography

• What is Coronary CT Angiography?
• How to Prepare for the Exam
• What to Expect
• Day of Examination

What is Coronary Artery Calcium (CAC) Scoring?
CAC is a non-invasive way of obtaining information about the location and extent of calcified plaque in the coronary arteries using CT. CAC has been shown to predict coronary artery disease (CAD) events more accurately than standard risk factors, C reactive protein and Framingham risk stratification1. The goal of calcium scoring is to detect CAD at an early stage prior to the development of symptoms.

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Who Should Have CAC Scoring?
Coronary artery calcium scoring is a screening study generally recommended by physicians for patients with risk factors for CAD but no clinical symptoms. The procedure is most often suggested for:

1. Men age 45 years or older

2. Women age 55 and above or who are postmenopausal

3. Patients at intermediate risk for whom a positive result would promote more aggressive medical management.

Major risk factors for coronary artery disease (other than age), include:

• High blood cholesterol levels
   
• Family history of heart disease
   
• Diabetes
   
• High blood pressure
   
• Smoking
   
• Overweight or obesity
   
• Physically inactive

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How is the Procedure Performed?
A technologist will have you lay on your back on the CT examination table. EKG leads are attached to the chest to record the electrical activity of the heart. You will hold your breath for less than 10 seconds while a CT scan is performed. No contrast is used. Radiation dose is 2 mSv, 2/3 of what you receive from exposure to sunlight and other ambient radiation annually. Time required for patient preparation and the actual CAC screening is generally less than 15 minutes.

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What Do the Results Mean?

• If the CAC score is equal to zero, you have a very low risk of major cardiac events over the next four years.
   
• A positive score means that coronary artery disease is present, regardless of whether or not you are experiencing any symptoms. The amount of calcification--expressed as a score--may help predict the risk of a heart attack in the coming years.
   
• A score between 1 and 100 is associated with a four-fold increased risk of heart attack over the next four years. Treatment of any identified risk factors such as blood pressure or elevated cholesterol is indicated.
   
• A cardiac score of 100 is associated with a seven-fold increased risk of heart attack over the next four years. Aggressive treatment of identified risk factors is indicated.
   
• If you have a CAC score greater than zero, you should review the results with your doctor to determine whether medical treatment or further diagnostic testing is warranted.

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Will the Exam be Covered by Insurance?
Insurance coverage is determined on a case-by-case basis depending on medical necessity. If the screening exam is not covered by insurance, the cost of the exam is $129. You will be responsible for payment in full at the time of service.

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Coronary CT Angiography
Coronary CT angiography (CCTA) is used to evaluate the:

• Heart muscle
• Coronary arteries
• Pulmonary veins
• Thoracic and abdominal aorta
• Pericardium (the sac around the heart)

A CCTA is a CT scan of the heart used to determine whether fatty deposits, also called plaque, have built up in the coronary arteries that supply blood to the heart muscle. If untreated, the plaque can decrease the blood flow to the heart muscle, which can cause chest pain or rupture, causing a heart attack.

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How to Prepare For the Exam

Your physician will prescribe a medication called metoprolo tartrate prior to the exam. This medication is a beta-blocker used to make the heart rate slow and consistent during the CCTA exam. You will be instructed to:

• Take one 50mg tablet of metoprolol 12 hours prior to your study
   
• Take the second 50mg tablet of metroprolol 2 hours prior to your study

• No food for 2 hours prior to the study (fluids without caffeine are fine).
   
• No caffeine for 24 hours prior to the exam.
   
• No erectile dysfunction (ED) drugs for 24 hours prior to the exam.

You will be called by an Imaging Services staff member to review medical history two days prior to the study. You should be prepared to answer the following questions for the radiologist to review prior to your study:

• Are you allergic to intravenous contrast?
• Are you asthmatic?
• Do you have a history of severe allergies?
• Are you diabetic?
• Do you take a medication called Glucophage or Glucovance (metformin)?
• Do you have kidney disease or kidney failure?
• Do you have heart disease, heart failure, angina, irregular heart beat, history of a heart attack, an enlarged heart or known coronary artery disease (CAD)?
• Do you have high blood pressure or high cholesterol?
• Are you a smoker?
• Is there any possibility you may be pregnant?

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What to Expect
You will be called by one of the technologists for a telephone interview about your medical history prior to the actual study. The radiologist will review your history prior to your study and determine if any additional information is needed. If you are over 50 years old or have a history of kidney problems you may be required to have a blood test to evaluate your kidney function prior to receiving any contrast agent.

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Day of Examination

• You will be brought to a patient monitoring area
   
• A nurse will review your medical history
   
• The CT technologist will place three small, sticky electrode patches on your chest. Chest hair may be partially shaved to help the electrodes stick. Your heart rate will be monitored before, during and after the study.
   
• The CT technologist will insert an IV line into a vein in your arm to administer contrast during your procedure.
   
• You will be asked to raise your arms over your head for the duration of your exam. You will receive a contrast agent through your IV to help produce the images. It his common to feel a warm sensation as the contrast circulates through your body. This is a normal sensation. Some patients may also experience a metallic taste in their mouth.
   
• Once the CT technologist is sure that all of the information is collected, you will be observed to make sure you are doing well. Your blood pressure and heart rate will again be checked. At this point, the IV will be removed and you will be sent home.

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