On this thread:
http://www.trackandfieldnews.com/discus ... hp?t=16852
Squack correctly pointed out that a cardiac stress test won't always be abnormal in people with significant coronary artery narrowings. In recent years, another way to try to get a handle on the likelihood of CAD (coronary artery disease) has been to pay $200 (insurance generally hasn't covered this) to have cardiac CT scan, which measures the amount of calcium laid down in the area of the coronary arteries. Calcium is usually a part of the gmish, along with collagen, fatty acids, cholesterol, and other stuff, that makes up the plaque that defines CAD. However, the correlation between a given person's calcium score on that CT test and the degree of narrowing of their coronaries is pretty poor.
I thought you all (or y'all, or you guys, or youse guys) would be interested to know that a new CT scan technology is upon us and will make it's presence known in the next 12 months, according to my cardiology colleagues. It will be called something like "CT coronary angiography" (and if I wasn't so lazy I'd do a search to pin that down and provide a link) and will allow the ordering doc to tell you "You have a 60% narrowing of your right coronary artery and a 40% narrowing of your left anterior descending coronary artery," without a cardiologist sticking a catheter in your femoral artery and threading it up your aorta to your heart to squirt dye directly into your coronary arteries. That procedure generally goes fine, but obviously has some risk. THe CT version will require an IV in your arm for contrast dye and a beta-blocker to slow your heart down for better imaging, but that's all. This will really useful in many situations. If you hit the ER with chest pain and you're a 55 year-old male and your EKG is normal, the ER doc won't have to agonize over whether you're going to drop dead three hours later in your living room if he sends you home. Down the hall to the CT scanner and if you've got an 80% narrowing, you get admitted, 20% and you go home. The doc will still have some agonizing to do if it's, say, 60% cause it still could be your heart. Or if you're age is 50 and your dad had a heart attack at 54 and your 57 year-old brother has had one and your cholesterol is borderline and your doctor has been straddling the fence about treating it and you'd like to know where things stand, this CT might be really helpful. A small amount of plaque and you're fine, a 40% narrowing and you better treat the cholesterol, lose weight , exercise more, etc.
I've not looked at any studies about the margin of error, probably +/- 15-20%, but that's about the same as the gold standard, the cardiac cath. One hitch is the cost-probably about $1200. It remains to be seen which insurance companies will cover this and under what circumstances. But there it is, today's healthcare news item. There are no such scanners in Colorado today, maybe one or two in Arizona and one in Wyoming, but I'm assured there will be three or four in Colorado Springs alone by the end of 2006.