What you need to know about:

Coronary CT Angiography

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Overview of

Coronary CT Angiography

in Thailand

Coronary computed tomography angiography (CCTA) is a heart imaging test that helps determine if plaque buildup has narrowed the coronary arteries, the blood vessels that supply the heart. Plaque is made of various substances such as fat, cholesterol and calcium that deposit along the inner lining of the arteries. Plaque, which builds up over time, can reduce or in some cases completely block blood flow. Patients undergoing a CCTA scan receive an iodine-containing contrast material as an intravenous (IV) injection to ensure the best possible images of the heart blood vessels. Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical imaging test. Like traditional x-rays, it produces multiple images or pictures of the inside of the body.The cross-sectional images generated during a CT scan can be reformatted in multiple planes. They can even generate three-dimensional images. These images can be viewed on a computer monitor, printed on film or by a 3D printer, or transferred to an external drive. CT images of internal organs, bones, soft tissue and blood vessels provide greater detail than traditional x-rays, particularly of soft tissues and blood vessels.

Goals of

Coronary CT Angiography

Many physicians advocate the careful use of CCTA for patients who have: -Suspected abnormal anatomy of the coronary arteries. -Low or intermediate risk for coronary artery disease, including patients who have -Chest pain and normal, non-diagnostic or unclear lab and ECG results. -Low to intermediate risk atypical chest pain in the emergency department. -Non-acute chest pain. -New or worsening symptoms with a previous normal stress test result. -Unclear or inconclusive stress test results. -New onset heart failure with reduced heart function and low or medium risk for coronary artery disease. -Intermediate risk of coronary artery disease before non-coronary cardiac surgery. -Coronary artery bypass grafts. For patients meeting the above indications, CCTA can provide important information about the presence and extent of plaque in the coronary arteries. Apart from identifying coronary artery narrowing as the cause of chest discomfort, it can also detect other possible causes of symptoms, such as a collapsed lung, blood clot in the vessels leading to the lungs, or aortic abnormalities. Your primary care physician or cardiac specialist, in consultation with a radiologist who would perform the test, will determine whether CCTA is appropriate for you.

Price of

Coronary CT Angiography

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Pros and cons of

Coronary CT Angiography

Pros

-CCTA is not invasive. An alternative test, cardiac catheterization with a coronary angiogram, is invasive, has more complications related to the placement of a long catheter into the groin or wrist arteries extending all the way to the heart, and the movement of the catheter in the blood vessels. Invasive catheterization requires more time for the patient to recover.  

-A major advantage of CT is that it is able to view bone, soft tissue and blood vessels all at the same time. It is therefore suited to identify other reasons for your discomfort such as an injury to the aorta or a blood clot in the lungs.  

-Unlike conventional x-rays, CT scanning provides very detailed images of many types of tissue.  

-CT examinations are fast and simple.  

-CT has been shown to be cost-effective for a wide range of medical problems.  

-CT is less sensitive to patient movement than MRI.  

-CT can be performed if you have an implanted medical device of any kind, unlike MRI.  

-No radiation remains in a patient's body after a CT examination.  

-X-rays used in CT scans should have no immediate side effects.

Cons

-A person who is very large may not fit into the opening of a conventional CT scanner or may be over the weight limit  

-Patients who are extremely overweight or who have abnormal heart rhythms may not be good candidates for this test because image quality may be compromised.  

-Unlike CCTA, which is only a diagnostic test, invasive coronary angiography can be used for both diagnosis and treatment in a single session. If a narrowing or blockage is found during a CCTA, it cannot be treated at the same time. Patients with a high risk of coronary artery disease and typical symptoms might undergo coronary angiography instead of CCTA because they are more likely to need treatment.  

-CCTA can be difficult to read if there are many areas of old, calcified (hardened) plaque, which can be the case in older patients.

How It Works:

Coronary CT Angiography

You'll receive numbing medication, and then the technician will insert an IV into your hand or arm. The dye flows through this IV. You'll also have sticky patches called electrodes placed on your chest to record your heart rate. You'll lie on a long table that slides through a short, tunnel-like machine (CT scanner). If you're uncomfortable in closed spaces, ask your doctor if you need medication to help you relax. During the scan you need to stay still and hold your breath as directed. Movement can cause blurry images. A technician operates the CT machine from a room that's separated from your exam room by a glass window. An intercom system allows you and the technician to talk to each other. Although the actual scanning portion of the test takes as few as five seconds, it may take up to an hour for the whole process to be completed.

Preparation before

Coronary CT Angiography

Pre - treatment

Your doctor will give you instructions about how to prepare for your CT angiogram. You can drive yourself to the appointment, and you'll be able to drive after your test. Food and medications- Usually, you'll be asked not to eat anything for about four hours before your test. You can drink water. Avoid caffeinated drinks 12 hours before your test because they can increase your heart rate, which can make it difficult to get clear pictures of your heart. Tell your doctor about the medications that you take. You may be asked to avoid or temporarily stop a medication prior to the test. If you have an allergy to contrast dye, your doctor might ask you to take steroid medication 12 hours before the procedure to reduce your risk of a reaction. Clothing and personal items - You'll need to remove clothing above your waist, as well as jewelry and glasses, and change into a hospital gown. You may receive a medication called a beta blocker to slow your heart rate. Doing so provides clearer images on the CT scan. Let your doctor know if you've had side effects from beta blockers in the past.You might also be given nitroglycerin to widen (dilate) your coronary arteries. The CT scan may be done using contrast, a dye to help your blood vessels show up more clearly. If you're allergic to contrast material, you might be given medication to lower your risk of a reaction.

Recovery after

Coronary CT Angiography

Post - treatment

You will be advised to drink plenty of water because the contrast medium is removed from the body via urine. Patients may have allergies, such as rashes or hives, several hours after the injection of the contrast medium. However, the chance is minimal. If such symptoms occur, immediately see doctors.

Risks & side effects

-In some people with abnormal kidney function, the contrast material used in CT scanning may worsen kidney function. -If contrast material leaks out from the vessel being injected and spreads under the skin where the IV is placed, skin damage or damage to blood vessels and nerves, though unlikely, can result. If you feel any pain in your arm at the location of the IV during contrast material injection, you should immediately inform the technologist. -There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk. -The effective radiation dose for this procedure varies. See the Radiation Dose in X-Ray and CT Exams page for more information about radiation dose. -Women should always tell their doctor and x-ray or CT technologist if there is any chance they are pregnant. See the Safety in X-ray, Interventional Radiology and Nuclear Medicine Procedures page for more information about pregnancy and x-rays. -CT scanning is, in general, not recommended for pregnant women unless medically necessary because of potential risk to the unborn baby. -The risk of serious allergic reaction to contrast materials that contain iodine is rare, and radiology departments are well-equipped to deal with them.

FAQs:

Coronary CT Angiography

How good is CTCA at evaluating for coronary disease?

CTCA is the most sensitive non-invasive tool in current practice for obstructive coronary artery disease. Numerous clinical studies reproducibly show a sensitivity for obstructive coronary artery disease of >95% and negative predictive value of >99%.

What happens after I get my results?

The images from your CT angiogram should be ready soon after your test. The doctor who asked you to have the CT angiogram should discuss the results of the test with you.  If your test suggests that you have or are at risk of heart disease, you and your doctor can discuss treatment options.

How do I choose between CTCA and stress testing?

Both are good tools to evaluate stable chest pain where a cardiac cause is considered. Current literature suggests CTCA may have greatest utility in patients where the probability of coronary disease is low or intermediate due to high negative predictive value – i.e. it is an excellent ‘rule-out’ test, whereas a negative stress test doesn’t always rule out angina. Stress testing may be the more useful test however when the probability of angina is high. Having said that, in real-world practice it is often patient-related factors that ultimately dictate the choice (poor mobility or poor echo windows suggest CTCA, renal impairment or severe asthma suggest stress testing – see next for more info).

Who Should Consider a Coronary CTA?

Patients who should consider a coronary CTA include those with:  -Chest pain, shortness of breath or other symptoms of coronary artery disease -Unclear or inconclusive stress test results -A strong family history of early heart disease -Multiple other risk factors for coronary artery disease (hypertension, diabetes, cholesterol abnormality, smoking)

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