Low Dose CT Coronary Angiography

What is it: Angiography is the “recording of blood vessels”. While the calcium score allows us to see if there is calcium present in the arteries of the heart, a CT angiogram provides even more information. Besides calcium, we can see if there is soft plaque which represents an earlier stage of atherosclerosis. We can also determine if there is so much plaque that blood flow through the arteries is reduced and therefore the cause of heart symptoms like chest discomfort and shortness of breath.

Who may benefit: CT coronary angiography is performed in people with stable and acute chest pain and shortness of breath syndromes that could be caused by plaque in the arteries of the heart. It is not a test to be done during a full-blown heart attack. It can be done as the initial test to evaluate symptoms or following a stress test that does not clearly give an accurate answer. Studies show it reduces the number of patients who need an invasive evaluation coronary arteries (invasive coronary angiogram).

How the test is done: To fully visualize the arteries with x-ray, we inject 1.7-2.7 ounces of iodine-based contrast through a small plastic tube called an IV catheter into a vein in the forearm using an injector to deliver the contrast in a controlled, safe and properly timed manner. The x-ray tubes inside the scanner will start to rotate making a bit of noise as you lay quietly with arms outstretched above your head. You will be asked to hold your breath and not move at all for a few seconds. Moving around or breathing during the test will result in poor image quality. The exposure to the x-ray beam is very brief and focused on the heart. In many cases, the x-ray beam exposure is about 1/10th of a second but not more than 1-2 seconds typically. Images will be reviewed for quality by the technologist and then the images will be transferred to a 3D workstation for analysis by the cardiologist using software that uses Artificial Intelligence. If necessary, with insurance approval your images will be sent to one of our partners to evaluate the blood flow characteristics or arteries with moderate plaque buildup. The IV will be removed, a bandage placed, and we will ask you to sit around to make sure you have no reactions to the contrast. Reactions typically occur within 20 minutes and if they happen at all, they are usually mild. Within 24-48 hours there will be a final report.

Preparation: 1. Drinks several glasses of water the day before the procedure. If you have an afternoon procedure, drink water throughout the morning. 2. No caffeine 12 hours prior to your test. This includes any type of coffee, tea, energy drinks. 3. Do not perform vigorous exercise in the 4 hours prior to your test.4. There is no need to fast, but the last meal consumed before the test should not be heavy. 5. Wear comfortable, loose-fitting clothing with short sleeves. Avoid metal buttons. Women may be asked to remove the bra. 5. Medications may given to control heart rate.

Premedication: Yes, if you have a history of allergy-like reactions to iodine-based contrast exams or if you had a rection and cannot remember the details.

Insurance coverage: Yes with prescription from a doctor for the evaluation of symptoms that could be due to disease in the arteries of the heart.

Bottom Line: This is the best non-invasive test to visualize the heart arteries that supply blood to the heart muscle. It can be performed with high quality imaging and low radiation exposure using the SpotLight DuoTM .