Anyone with CT angiogram experience ?

[p1954]

About 16 months ago I had two stents put into my right coronary artery.   I also had two other coronary arteries 20 to 30% blocked.    The two stents which were put in are in series and make an effective stent length of 35 mm.   So, I don't like the stent length or the increase risk of fracture due to their interlock, both of which increase risk of complications.   My carotids were 20% blocked at the time as well.  

So far no issues, except compromised heart function (systolic and diastolic dysfunction and LV wall stiffness) due to MI which I had 16 months ago as well.   Not sure where that is going as I now also have pulmonary hypertension.

I have been exercising and eating well, and keeping LDL < 70.

I would like to assess my heart (and stent) non-invasively if possible at some point soon to obtain information which an echo can't provide.. I see where CT angiograms are available and wanted to know if anyone here has used the test to assess their heart condition, and if so, what they were able to learn.  

[green_been]

You are very welcome. Tomorrow I have an apointment with the doctor who did my stress test and booked my for an angoigram. I think I am going to ask for the 64 slice CT angiograph even though it will cost me $1300. I am starting to think I should get a second opinion before I let someone shove a wire into my heart. It seems like everyone has the opinion that I should just get the angiogram and not worry , but I just don't see why if I am willing to pay for this, how an additional test could possibly hurt. I just read an article that in the USA 12% of all stents installed should not have been done, 38% were questionable and 50% were the right call. This pertains to people with stable heart disease. Also stent implantation is one so the most lucritive medical proceedures.

[green_been]

So after getting the above info I asked the question about radiation and this was the answer.
With respect to the radiation dose, radiation exposure is cumulative over your lifetime, so time between scans is not relevant - exposure is exposure. That being said, if there is information that can be obtained from the test to better enhance your medical management and/or diagnose a problem then your doctor will weigh the risks of more radiation exposure versus the benefit of the information that can be obtained. Historically, the Coronary CT Angiography had a radiation dose of approximately 2 - 5 mSv (depending on patient size). However, we recently moved into our new clinic space at the beginning of November and with our new CT scanner have been able to reduce the radiation dose by up to 1/3 on most exams. It is the first low dose private CT scanner in Western Canada. To give you a reference point, the average person living in Canada receives approximately 3.5 mSv per year in background radiation.

[p1954]

I just found  a 2011 abstract from the which says that dose can be reduced to approx. 1 mSv given newer CTs with voltage optimized.   1 mSv is roughly equivalent to dose from about 4 months or less of natural background radiation.   Didn't check to see what the best dose was from more conventional angiography.   For me, 1 mSv is worth the risk of getting a clear picture of what's happening with my heart, and associated vasculature, without the risk which accompanies cardiac catheterization.
  "Radiation dose at coronary CT angiography: second-generation dual-source CT versus single-source 64-MDCT and first-generation dual-source CT"  C. Fink, et. al.  American Journal of Reontgenology, 2011

[ayl291]

Do you have pulmonary arterial hypertension or pulmonary venous hypertension?

[ed34]

I can honestly say that you will be fine and you will be here to report your experience. My cardiologist (consultant) works across three hospitals. Each has 3 angio suites and patients are in and out all day in all of them. They have never had a fatality yet or caused a stroke. I really wish there was some way I could relieve your fear, or even have the procedure for you because they really don't bother me. Just ensure you urinate before going in because the dye they inject seems to excite the bladder a bit. They will say "sharp scratch" and they inject the anaesthetic to the incision area. You lay there waiting to feel the catheter going in but when you look round at the screen, they are already in there. They will probably do the occassional 'flush' as they call it, where they send a large amount of dye into the aorta or ventricles, and you may feel a dull ache in your chest for about 5 seconds. Sometimes it causes a high heat sensation down one side of the body, again about 5 seconds. Try to watch the screen, its fascinating to see your own arteries and the expertise they have. It's even more relieving to see the before/after pictures of the blocked artery. They will come to your bed when you are waiting, to get you to sign the consent form. When you hear the words "you could have a heart attack, stroke or die" it does make your heart race. But keep it in perspective. All those patients who went before you and were treated yesterday were fine. Why should you expect anything different :)  Oh and as a last thing, for goodness sake don't move while on the table. I forget sometimes and go to scratch my head, but you have to ask a nurse to do it. I've been shouted at on many occasions lol.

[Flycaster305]

It sounds to me like you made an excellent decision.  As Ed pointed out, why get extra Rads?  The gold standard is a stent.  Like Ed, I've had close to dozen of them, and have been very fortunate that they have remained patent over a fourteen year period.  Like Ed, I didn't have that good fortune with bypass surgery, the veins failed.  I'd procede with a great deal of confidence with a stent, then help your body by making sure you maintain a healthy diet, exercise and weight.  Keep us informed.

[heartfluttersflyawayplz]

Glad, you and yourDr got it all figured out and prayers for you to have it, and come out good

My friend just had one and she said it was not bad at all, she was so scared but said it was pretty cool watching it, she went in with chest pain, jaw pain and left arm pain, they just knew she had a blockage, but she didn't , all was clear,

Turn out to be stomach/ hernia problems, can never tell

[green_been]

Well I just came back from the doctor. We had a very long and in depth appointment. My 1st appointment with him when he told me about my test results was about 2 minutes long. He told me I had a blockage. I had to take 3 drugs, he told me how to use nitro, made me eat an asprin, told me not to travel. He told me he booked me for and angiogram and I had a 1/1000 chance of dieing, or stroking out during the proceedure and sent me on my way. This time he gave me all the info I was needing to hear. He told me how well respected my Cardioligist is. He explained the results of the test which convinced me I definitly have a problem and he even said he would send me for a CT scan if I wanted one but it would delay my angiogram and probable angioplasty/stent. Anyway I am going for the angiogram as scheduled and will not be getting a CT scan which is a lesser test.

[ed34]

Yes you just have to love conspiracy theories don't you. It's a bit like the guys who say statins are just money spinners and the medication in not only unnecessary but will kill you long term. The reason I went three years with no problems and then had a heart attack a few weeks ago is because I stopped my medication. Correct me if I'm wrong, but I get a strong feeling that you are trying to find any reason not to have an angiogram due to fear. This is understandable, I was terrified before my first one, but after at least 12 now, it's a walk in the park. If it is fear, don't let it prevent the best test you can have at the moment. Stents are not, and I repeat not, put into arteries when not needed. There are strict policies which are followed and those are decided on by experts. A blockage less than 70% is usually left alone. 70% and above is not stented simply because of blood flow restriction, but because the plaque cap is a high risk for rupture and killing you. Many people don't feel symptoms less than 90% and are walking around with a possible time bomb. Another thing to realise about CT is their calcium scoring. This measures how much calcium is lining the arteries and gives an indication of the amount of disease. But you know what? it's not accurate. Many blockages have no calcium, they are just pure fat or clotting material which is not capped. They found many patients were having calcium scores of 0, then dying of heart attack. They believe they've kind of tweaked a chart now, saying certain ethnic groups are at risk with 0 calcium. So if 0 means risk, then why the test? Now 'THERE'S' a conspiracy theory :)

[p1954]

thanks.  that was informative...

[green_been]

Here is some info about the CT scan I have received. It is one of the reasons I have a tough time rapping my head around why so many think Angoigram should happen 1st.
This scan will identify the location and severity of coronary artery narrowing (stenosis) as well as evaluate the vessel wall and the nature of the atherosclerotic plaque (soft versus calcified). It will also provide anatomical cardiac information. The cardiac chambers, valves, myocardium & epicardium can be assessed for abnormalities and it will also provide the calcium score (percentage of hard plaque in the arteries). The only limitation of this test compared to the conventional invasive angiogram, is that we cannot undertake any interventions such us angioplasty or stenting during our procedure as it is non-invasive.

[Cherbot]

I had a CT scan first.   It showed 70-90% blockage in all arteries.    I was then sent for an angiogram with the expectation that I would be getting stents in all arteries or with the extensive blockage more likely I would be having bypass surgery.   They did the angiogram and there was no blockage with the exception of one vein and it had approximately 30%.   The CT scan was absolutely worthless.   I should have just had the angiogram.

[ed34]

I would first ask your cardiologist if they are happy with a ct angiogram. I've been under a few cardiologists over the years and none have liked ct at all. When I've asked why, they've all give the same reasons "they are not very clear and leave doubts".

[Occupant]

Published results show an Angiogram with 7mSv if it is only diagnostic and a CT-A at 16.0mSv. Therefore, the X-Ray load is more than twice as high for the CT-A.

[ed34]

I believe that the amount of radiation exposure is much higher with ct over a standard angiogram. Everyone talks about risks, but if you want clear results, an angiogram is the best option. If your CT shows a blockage, you will have to go for an angiogram anyway. The risks are very small indeed with an angiogram.

[p1954]

yes, there is an x-ray load with a CT angiogram, but a cath-agiogram also has an x-ray load, as that is how they get the images, but with the added risk of being more invasive..

[p1954]

No, nothing wrong with stents (to my knowledge).   But I feel like I'm flying in the dark to some degree.  It seem reasonable to me to try track my cardiac condition with the best tools to increase likelihood of heading off a problem "before" it becomes symptomatic or outright kills me.    Seems to me that  a CT angiogram is less risk than a cath angiogram, both requiring some amount of radiation, but the cath carrying addition risks due to being more invasive.  

[ed34]

If there is anything wrong with the stents, it is very likely you will have symptoms which reflect it. I had a few stents close up, and one was just a few weeks ago. I certainly knew about it. I didn't have chest pains, I just felt so light headed I wanted to pass out and I went as white as a sheet. My youngest Son (19) squirted GTN into my mouth and fed me lots of Aspirin, then called for an ambulance. By the time I reached the hospital I felt much better and the angiogram revealed a closed stent but more collaterals open. I still think the aspirin and gtn did the trick.

[Occupant]

I haven't done it yet, thinking about it. What I don't like is the high X-Ray load it puts on you and I haven't found any place close by that does an 128-slice CT-A. Anything else I don't want to do other than if I can get an even higher resolution yet. I know the Cleveland Heart Clinic offers a 256-slice scan - pretty long drive, though. For the CT-Scan (I had that done 2 years ago) I had to pay myself - insurance wouldn't cover it and I wouldn't do that again anyway, pretty much useless. So, I am leaning towards an Angiogram at this point - I have yet to talk to a cardiologist.