Suppose you’ve been wanting a CT angiogram, and your cardiologist has informed you that the CT angiogram would be pointless —

— because your very high calcium score indicates that all the calcification in your arteries would obscure the images on the CT angiogram.

What should you do at this point?

“A CT angiogram has limitations if there is severe calcification (a calcium score > 800),” says Dr. Larry Santora, MD, cardiologist, medical director of cardiac CT, and medical director of the Vascular and Wellness Center, Saint Joseph Hospital, Orange, CA, and author of “OC Cure for Heart Disease.”

He adds, “There is a good chance the CT scan cannot see through the calcium to see the lumen (channel) of the artery. High scores are a relative contraindication.”

So if your physician says that the CT angiogram is out, due to a very high calcium score, this is the real deal, unfortunately.

It’s likely that one day, technology will advance enough to create a way for a CT angiogram to read through the heavy calcification.

Until then, you are left with the next step, which is a “stress test,” which can be done via exercise to stress the heart, or chemical stress (usually given instead of exercise if the patient cannot carry out sufficient physical exertion, e.g., patient has osteoarthritis).

Dr. Santora says, “If the stress test (nuclear or stress echocardiogram) is normal, you do not need a CT angiogram.”

This will sound surprising to the patient who has a very high calcium score, since the higher the calcium score, the higher the likelihood that he or she will have a heart attack in the next several years. The correlation between the two is well-established.

“The stress test becomes abnormal when there is a narrowing of at least 70% in the coronary artery.

“Such a blockage may benefit from a mechanical fix, like an intracoronary stent or coronary bypass.

“The idea is if the stress test is normal, there is no restriction of blood that requires such a fix.”

But Dr. Santora explains that there are two key indications for the CT angiogram:

No. 1: “A stress test that is equivocal for decreased blood flow — that is, it is a little abnormal, but not enough to make a diagnosis.”

And No. 2: “Unexplained chest pain.”

If the patient with the very high calcium score undergoes a stress test with normal or negative-finding results, and he has not been having unexplained chest pain, then he does not need the CT angiogram. Dr. Santora says that CT angiograms are not screening tests.

So if you’re this type of patient with the exceedingly high calcium score, but a normal stress test result and no chest pain … what is your next step?

Well, it certainly isn’t to go home feeling safe, because there is a reason why your calcium score is so high.

You need to go on an aggressive treatment to prevent further calcification of the arteries, increase stabilization of the plaque, prevent or slow further plaque buildup, and even reverse some of the plaque buildup.

A normal stress test does not rule out the presence of the dangerous kind of plaque – the “soft” and unstable plaque that is prone to rupturing and causing heart attack.

Do not let a normal stress test fool you. A stress test simply detects blood flow through arteries.

It cannot tell how much soft plaque you have! The CT angiogram can do this.

But the CT angiogram, again, is pointless if the images are obscured.

Hence, you absolutely need to commit to aggressive treatment, which comes in the form of a change in diet, addition of supplements, and prescription drugs that are designed to put some brakes on coronary plaque buildup.

Daily, structured exercise is also part of this plan. If you smoke, quit, once and for all.

Dr. Santora’s areas of interest include interventional cardiology – coronary stenting, cardiac CT – CT angiography, and coronary calcium screening with EBCT.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  

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Top image: ©Lorra Garrick