Early Detection Saves Lives

It’s a simple procedure that takes about 15 minutes, provides quick, easy-to-understand results and is relatively low-cost. It can also save lives, yet not many people know about it. What is it? The coronary calcium scan, or heart scan, is a non-invasive imaging test that many cardiologists view as one of the best available tests, beyond typical risk factors such as cholesterol levels and family history, for measuring cardiac risk. In short, it helps patients assess their future risk of having a heart attack. We sat down with Aurora Denver Cardiology Associates’ Dr. Sundeep Viswanathan, who practices at The Medical Center of Aurora, to discuss the test in further detail.

How common is coronary artery disease?

Heart disease continues to be the No. 1 killer among both women and men in the U.S., but many brush off atypical heart attack symptoms like shortness of breath, lightheadedness and extreme fatigue as less life-threatening conditions. The truth is that signs of a heart attack are often subtle and, if left untreated, can have deadly consequences.

What does the coronary calcium scan measure?

The amount of calcification in your heart arteries. Calcium is part of the process of atherosclerosis, or the building up of cholesterol and fat in your heart arteries, which can lead to heart attacks. It’s one of the only ways to directly visualize this process.

What type of patient is a prime candidate for the scan?

The test is meant for intermediate- to high-risk asymptomatic people who do not already have coronary artery disease (i.e. stents, bypass surgery). Prime candidates include those with a strong family history of cardiac disease, obesity, diabetes, high cholesterol, hypertension or smoking. Typically, men should be over the age of 45 and women over 55.

How are the results recorded and communicated?

Results are mailed to you and your doctor within 48 hours. You will have a score as well as a percentile based on your age and sex — the higher the score, the higher your risk. The report includes easy-to-follow tables and pictures of your heart arteries.

What happens with patients who have higher numbers? Is there usually medical intervention involved or can the results sometimes be addressed with lifestyle changes?

I typically recommend lifestyle changes for most patients first. This includes diet, exercise, weight reduction, smoking cessation and control of blood pressure, cholesterol and blood sugars. If that alone is not enough, medications such as aspirin and statins can help prevent progression of the disease.

Do the scan results motivate or inspire patients to consider serious lifestyle changes?

I find that the adage “a picture is worth a thousand words” fits well here. Many patients don’t understand how cholesterol or blood pressure plays into coronary artery disease, but everyone understands when you show them a picture of their heart arteries with calcium build up. For many, the scan can be reassuring that they have zero plaque in their arteries and, for others, it provides further motivation to make lifestyle changes or take medications.

What about those lifestyle changes?

No matter the age of his patients, Dr. Viswanathan says his advice for preventing heart disease is “always the same.” His suggestions include:

  • Get 30 minutes of moderate-intensity exercise daily; this can be something as simple as a walk.
  • Don’t smoke —your coronary heart disease risk is cut by 50 percent one year after quitting, notes the American Heart Association.
  • Men should limit themselves to two alcoholic drinks a day, and women one drink.
  • Avoid a diet high in saturated fat/trans fat.
  • Eat plenty of fruits and vegetables.

Does the scan hurt? What should I expect?

The scan itself, says Dr. Viswanathan, is one of “the easiest tests you can undergo — it is painless and quick and takes only one minute to scan your heart.” The whole procedure takes 10-15 minutes. What else to expect:

  • Patients have electrodes taped to their chest and, while in the imaging machine, will be asked to hold their breath for a few seconds.
  • The scanner is a large machine that has a hollow, circular tube in the center, much like an MRI machine. Patients lie on their back on a sliding table, and the table goes inside the tunnel-like machine. (For those uncomfortable in tight spaces, it’s important to note that the head remains outside the scanner}.
  • Finally, wear comfortable clothes, remove jewelry and avoid any caffeine intake for 12 hours prior to the scan.

Symptoms: Men vs. Women

Most of us know the classic heart attack symptoms: chest pain (especially after exercise — see “Safer Passage,” page 34), light-headedness or dizziness, fatigue. What many people don’t know is that women can have “very atypical” heart attack symptoms, says Dr. Viswanathan. “Often there is no chest pain.” Women, he says, are more likely to exhibit the following symptoms than men:

  • nausea or vomiting
  • stomach pain
  • shortness of breath
  • diaphoresis (extreme sweating)
In the end, whether you’re male or female, trust your intuition and don’t dismiss your symptoms. “You need to have a high index of suspicion and listen to your body,” says Dr. Viswanathan.