Analyzes the calcium in the coronary arteries can detect early heart disease
Cardiovascular diseases are the leading cause of death in men and women in the United States. Approximately 50% of acute myocardial infarction occur in people with no history of coronary artery disease. Sudden cardiac death is often the first sign of coronary heart disease. Coronary atherosclerosis is a slow progressive disease that often goes unnoticed until the person develops symptoms. By the time symptoms begin to appear coronary artery disease is usually in a relatively advanced stage, which require either percutaneous revascularization or surgical. The opportunity for disease prevention or modification of aggressive risk factor is missed. What is needed is a way to identify people asymptomatic are at high risk of cardiovascular events early in their disease process. Traditional cardiovascular risk factors are well established (levels elevated lipids, hypertension, smoking, obesity, lack of exercise, diabetes, family history of heart disease) and useful for predicting future cardiovascular disease. Many people suffer cardiovascular events but in the absence of these risk factors established coronary artery disease.
Heart attacks usually occur in patients with mild moderate stenosis of the coronary artery that develops and plaque rupture leading to acute thrombosis. These mild to moderate coronary lesions may not cause symptoms and / or not enough to cause ischemia be collected during a routine stress test.
During the early stages of coronary atherosclerosis, calcium begins to accumulate on the plate. As the atherosclerosis progresses process increases the amount of calcification. During the advanced stages atherosclerosis, a large amount of coronary calcification may be present.
Women have been reported as coronary artery calcification unless men and the average prevalence of calcification in women is around a decade later than men, as the incidence of cardiovascular events. The calcium prevalence among adults 30-39 years old is 21% for men and 11% for women, while in adults 40 to 49 years of age the prevalence is 44% in men and 23% in women. A recent study found that coronary calcium scores were similar in African American and Caucasian women despite the fact that the African American women had more risk factors. Diabetes mellitus and not exercising regularly is associated with increased coronary artery calcium scores in women white but not African-American women. The overall prevalence of calcium in women is approximately half of men until age sixty. Another study in asymptomatic women found that smoking, elevated levels of total cholesterol, and hypertension were associated with high scores for coronary artery calcium. Deposits Calcium is also found to increase with age irrespective of gender. Patients with diabetes and in patients with ESRD requiring hemodialysis presented a higher prevalence of calcium. Cardiovascular risk factors a person has higher prevalence of calcium.
Atherosclerosis is the only disease process are known to cause calcium to deposit on the walls of the coronary arteries. The calcification is a degenerative disease, is not a part of the "normal" process aging. Calcium is not found in normal coronary arteries.
Since calcium deposits begin to develop in the early stages of atherosclerosis and if we can identify the presence of calcium that are able to identify preclinical coronary artery disease during the asymptomatic phase. This may allow an application of the early aggressive risk factor reduction.
The calcium score screening heart scan is a noninvasive test that detects deposits calcium in the coronary artery walls. The test is performed with a cat scan electron beam (electron beam) that can scan at high speed. The images are triggered assisted ECG monitoring during diastole and a second breath hold to eliminate several motion artifacts. The scan only takes about thirty seconds software and then quantifying the calcium area and density.
The electron beam detects the presence, location and extent of Calcium deposits in the coronary system. Separate calcium scores may be obtained from the left main artery, left anterior descending artery, left circumflex and the right coronary artery, but the total calcium score is more important. The electron beam can detect tiny deposits of calcium that is normally present with early disease of the coronary artery. The presence of coronary calcification represents the coronary artery disease. People with low total calcium scores are in a lower risk of heart disease than high scores.
calcium scores range from zero (no plaque) to several thousand (extensive plaque) and is a measure without units calculated for the entire coronary system. A calcium score of zero indicates the absence of calcium and a very low likelihood of obstructive coronary artery disease. A score of calcium calcification than 400 and represents a high probability of significant coronary artery disease. (See Rating Chart calcium) These people should undergo further evaluation with stress test or nuclear stress test with myocardial ischemia. The higher the total score the greater the burden of plate. asymptomatic persons with an intermediate calcium score require a comprehensive risk assessment and modification of individual risk factors. A person age and gender should be taken into account when assessing the results of calcium score. A calcium score of 175 can be half of a male, 65 years old, but very abnormal for a woman of 55 years.
Calcium scoring scan is not able to identify the location of a lesion of significant coronary artery or to identify the percentage of stenosis. The amount of calcium in the coronary arteries predicts that the total atherosclerotic plaque mass and the likelihood of developing future cardiovascular events. coronary calcium reported that an independent predictor of angina pectoris, myocardial infarction, cardiovascular death, and the need for coronary revascularization. A study in asymptomatic adults, 20 to 69 years 18 months found that monitoring the rate of myocardial infarction and cardiovascular death was 6.6% in people who had calcium in the exploration versus 0.9% in people without any calcium. A direct relationship between calcium scores and increasing occurrence of adverse events. Asymptomatic people with high calcium score (> 1.000) was found to have an approximately 25% per year of developing a myocardial myocardium of cardiovascular death. A recent study of asymptomatic adults over age 45 with at least one cardiovascular risk factor found a fourfold increase cardiovascular risk in patients with calcium scores of the coronary arteries of more than 300. A study in symptomatic patients found that a score of calcium in the coronary arteries of more than 170 was associated with an increased risk of obstructive coronary artery disease regardless of the number of risk factors present.
A recent meta-analysis reported a sensitivity of 92.3% and 51.2% specificity for the accuracy of the electron beam to diagnose obstructive disease coronary artery. This makes the overall prediction accuracy of approximately 70%. One advantage of the analysis is that there is no false positive scans, calcium deposits are found only in the presence of plaque. InterScan reliability of the calcium scores has been questioned and has been reported to vary more with less punctuation. One study reported a variability of calcium score of 28% women and 43% in men when repeat examinations were performed in the same individual. This really needs to be evaluated and may be even more dependent on the facility, the medical team of the interpretation of results.
non-calcified plaque, soft will not be detected electron beam. Younger patients who smoke heavily, can not have calcium deposits, but are still at high cardiovascular risk and likely to spasm and thrombus formation. It has been some research suggesting that patients with unstable angina are less likely to have calcified plaques that patients with stable angina. Younger patients may develop significant stenosis in the absence of calcification. This may falsely reassure people who are at high risk. There are insufficient data to support the use of coronary calcium scans in symptomatic patients who already know that at high risk.
Coronary Calcium (EBCT) is more useful in asymptomatic patients with intermediate risk, to help determine the need for aggressive treatment of risk factor. (See The calcium Coronary Artery Scans box below)
Traditional non-invasive tests to assess coronary artery disease (stress test, nuclear scans, echocardiography stress) only detect coronary lesions that are severe enough to limit blood flow and cause myocardial ischemia. People with arterial disease or very mild coronary atherosclerosis early anonymity. Coronary calcium screening can identify non-obstructive coronary lesions; onset of symptoms. people asymptomatic calcium scores are also more likely to have abnormal nuclear stress tests indicative of silent ischemia. In one study 46% of patients with calcium scores of the coronary arteries of more than 400 had an abnormal nuclear scan, while 0% of patients with coronary artery calcium score under 10 had an abnormal nuclear scan.
EBCT can be shown to be more beneficial for women of detection. Often women are with atypical symptoms and are more likely false positives of effort and / or nuclear scans. Calcium scoring scans is reported to have a higher predictive value for significant coronary disease in women and less false positives than men. The negative predictive value in a study of symptomatic patients was 96% women and 89% in men. Women with normal lipid levels are also more likely to experience angina pectoris / myocardial infarction than men. The standard lipid profile does not always adequately reflect women's cardiovascular risk. A study of asymptomatic women over 55 years of age with lipid levels normal score are elevated coronary artery calcium. This is an area that needs to be evaluated further, but suggests that calcium results in coronary arteries can be very beneficial in evaluating cardiovascular risk profiles in women.
Indications for Coronary Artery Calcium Scans:
1. Family history of heart disease (heart disease, especially premature infants)
2. History of smoking
3. Hypertension
4. Obesity
5. Elevated lipid levels
6. Diabetes
7. Men over 40 years of age or postmenopausal women
8. Young people with atypical symptoms
Contraindications for Coronary Artery Calcium Scans:
1. Known coronary artery disease
2. People over age 70 (Little clinical benefit)
3. Pregnant women
4. Arrhythmias (chronic atrial fibrillation, resting tachycardia - heart rate greater than 90 beats per minute)
compromising image quality
The average calcium scores:
Men
<40 years 0
45 to 49 years at age 0
50-54 years of age 5
55-59 years of age 36
60-64 years of age 95
201 65 to 69 years
70-74 years of age 302
> 74 years 521
Women
<40 years 0
45-49 years of age 0
50-54 years of age 0
55-59 years of age 0
60-64 years 0
65-69 years of age 8
70-74 years of age 28
> 74 years 149
About the Author
Carolyn Strimike is a nurse practitioner specializing in health and wellness, co-founder of Heartstrong, LLC. People make hundreds of choices every day. Heartstrong is the healthcare company that will help you make healthy well-informed decisions that will allow you to live a longer, healthier and wealthier life. Visit our website www.heart-strong.com for more info or join us on our blog http://heartstrong.wordpress.com/ or follow us on Twitter http://twitter.com/HEARTSTRONG1. Join me on LinkedIn http://www.linkedin.com/in/heartstrong
Heart Disease - Coronary Artery Disease (Part 2 of 3)
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