Calcium Scoring Explained
What is a Cardiac CT for Calcium Scoring?
This test is a CT scan that looks at the arteries around your heart to see if they are narrowed or blocked. That is important because if the arteries are blocked, that can be an indication of a higher risk of a heart attack.
Has A Doctor Ordered This Test For You?
If your doctor ordered a cardiac calcium scoring test, you might wonder why. Maybe you have been feeling chest pains, or maybe your haven't. My mother's doctor ordered this test for her, and she was very concerned because she didn't understand what the test was all about. She had never had any heart pain.
While I'm not a doctor, both my husband and I are researchers and teachers, so I researched all about this test and put what I learned in plain language that my 78-year-old mother could understand. I know my mom is not alone in feeling confused about what the doctor says, so I decided to write a plain-language description to help others, as well.
Summary of Article
What is a Calcium Scoring CT Exam?
Why a doctor orders the test.
What information it gives.
What the scores mean.
Risk factors for heart disease.
Why you should get this test
What Kind Of Test Is Calcium Scoring?
An x-ray allows the technologist to see your bones. But a CT (computed tomography) takes images of your organs and soft tissue in great detail. Many images are taken at a time from different angles. When these images are put together, they create a 3-D image.
If you've ever had an x-ray, you know that it shows the bones of the body but not the other organs. CT (computed tomography) scans are like x-rays but they are able to take many images at a time from different angles. In fact, CT scanners can even put those images together so that they create a 3-D image. Most importantly, the CT scan can create pictures of the soft tissues of the body in a great deal of detail.
Why Doctors Order This Test
A cardiac CT for calcium scan allows doctors to see inside your body and look at your arteries in a non-invasive way. Before these scans, doctors had to use other indications or even surgery to decide if a person needed treatment, but now they can look at a 3D image to discover any issues. In addition, because these images are digital, the doctors can view them immediately and even send them to another specialist for another opinion.
What Is The Doctor Looking For?
When the doctor receives the scan, he will be able to look at your coronary arteries, which are the vessels that supply blood with oxygen to your heart. The doctor will be looking to see if you have:
- Blocked Arteries: a build-up of plaque and fat under the inside layer of the artery which can make the artery narrow so that blood can't flow through. This can cause chest pain called "angina" or a heart attack.
- Coronary Artery Disease (CAD): a disease of the blood vessel wall when plaque has built up and calcified. This can cause a heart attack.
The calcification in CAD can be seen by the calcium scoring CT and measured and, as the name suggests, "scored." Knowing the amount of calcium helps the doctor know the stage of the disease.
What Can You Expect?
This test is not painful. You will lay down and be instructed to lie still as the scan is performed. Sometimes, you will be asked to wear a hospital-type gown. Typical instructions may also include:
- Don't eat, drink or smoke for four hours before the exam.
- Don't wear jewelry.
- Wear loose, comfortable clothing.
- Remove metal objects like eyeglasses, dentures, unwire bras, piercings and hearing aids.
- Tell the technologist if you might be pregnant.
What Results Mean
What it means
Risk of Heart Disease
Risk is very low
Risk of coronary artery disease is low, under 10% risk
Definitely have plaque
Mild or minimal coronary narrowing
Definiely have moderate atherosclerotic plaque
Mild coronary artery disease highly likely and significant narrowing is possible
High likelihood of at least one significant coronary narrowing
These scans might be ordered if you have had symptoms of heart pain, but they are also used to screen people who have risk factors for CAD such as:
- high blood pressure
- high blood cholesterol
- a family history of heart attacks
- overweight or obese
- physical inactivity
Calcium Scoring Exam
Should I Get This Exam?
If your doctor orders this test, you probably need to get it. Because this test can find potential problems of heart disease before you have symptoms, you will be able to get treatment that could prevent a heart attack or other heart problem. Your doctor wants to be sure that you are treated as soon as possible to keep your heart healthy.
Younger people may wonder why they need this test. In fact, people who have some of the risk factors for heart disease may be recommended for the test at about 45. This is an important screening because until it became available, it was difficult to identify coronary blockages before a heart attack. By tracking your score on this test, your doctor can tell how healthy your heart is.
If you have a high score, what is the doctor likely to suggest? Your doctor will be looking at more than just your calcium score in making treatment suggestions for you. The main goal will be to reduce your risk of having worsening heart disease. Here are some things the doctor may suggest:
- Treating high blood pressure with exercise, medicines or diet.
- Making sure you get regular, moderate exercise as part of your lifestyle.
- Treating lipid disorders if present.
- If you smoke, stopping smoking will be advised.
- If you are diabetic, getting your blood sugar under good control will be part of the plan.
- Medicines like aspirin and statins may be advised.
If you have a high score, your doctor may also want to do more evaluation. Here are some tests they may suggest:
- Stress Test: You will walk on a treadmill while being monitored by an electrocardiogram (EKG) which and show how your heart is working.
- Stress test with a nuclear and echocardiographic imaging: If, like my mom, you can't walk easily on a treadmill, your doctor may order this test instead. What they do is to artificially make your heart beat faster and then use an agent (like thallium or technetium) that is taken up by your heart and let the doctors see more clearly what is happening when they take an image.
- Coronary catheterization with angiography: If your doctor is pretty sure there is a problem and wants to see exactly what is happening, they may order this test because it not only lets the doctor see the problem more clearly, it can also let them do some treatment. In this test, the doctor uses a catheter (small tube), x-ray imaging and an injection of a contrast material to look at your blood vessels.
Why are you interested in finding out about this test?
How To Make Doctor's Visits Most Helpful
Cost: If you have questions about the cost of the exam, be sure to contact your insurance agency or doctor's office to discuss your options.
Understanding Doctor's Recommendations: If you don't understand why your doctor thinks you may have heart disease, be sure to ask them. Did you forget something during your appointment? Call up the office and ask to talk to a nurse so you can ask your question.
Write Down Information: Write down the questions you have for your doctor before your appointment and write down the doctor's answers or ask for a handout about your condition. I've done this with my mother and it has helped her to keep track of what the doctor says.
Ask Someone to Go With You: In addition, if you don't feel comfortable talking to the doctor or worry you won't understand, you might want to take a friend or relative with you. When I go with my mom, I often find that we both remember different parts of what the doctor said. After the appointment, you can talk together and write down what you remember. That can help you to feel more calm and prepared for your tests and treatment.
Calcium CT scoring exams are an important tool for doctors to check on your heart health and if your doctor has ordered the exam, you should probably be sure to have it done and follow any treatment advice. Don't be afraid to ask questions to make sure you understand what the doctor is doing to protect your heart health.
Questions & Answers
My score was 132 in one artery. Is that a problem?
Only your doctor can look at your score and explain how it specifically relates to your medical and health condition. I provide information here for you to understand your score better and what it means but I urge everyone to discuss any concerns with your doctor. It is worth making another appointment with the doctor to discuss your scores. What happens a lot with me is that my doctor sees me, then orders tests and then I get the results either online or through a call with the nurse. Often they just say "everything looks ok" or "you need to work a bit on..." If you have concerns about the tests, you need to research as much as you can, write your questions down, and then make an appointment to talk with your doctor. Often the nurse who sees you first will ask you what questions you have. You can hand the nurse your list of questions, and that might help you get better answers (maybe make two copies, one for the doctor and one for you). The second idea is that you might be able to contact the doctor by email or through your online medical portal.