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Before a CAC scan can be booked..

At a glance..

Even before you have a scan there are many questions people have about whether it is the right thing for them or a loved one to have. Click below to see a list of frequently asked questions and our cardiologists' answers.

Back to Q and A

What is a coronary artery calcium (CAC) scan?

A CAC scan (HeartScan) is a targeted heart CT scan which assesses whether there is calcium within the walls of the arteries that supply blood to the heart muscle (coronary arteries). Dangerous coronary artery narrowings are caused by the deposition of cholesterol into the walls of arteries. After the cholesterol has been laid down it gradually hardens with calcium. The calcium is easily visible using x-ray and a modern CT scan allows for the accurate measurement of how much calcium is present in the arteries. There is extensive scientific evidence that the amount of calcium present is related to an individual’s risk of having a heart attack or dying of heart disease and that given the appropriate targeted medical treatment these risks can be dramatically reduced.

What is a CAC scan useful for?

CAC scanning is useful to detect the presence of coronary disease and assessing one’s personal future risk of having a heart attack. This can help guide lifestyle decisions and therapeutic interventions for the prevention of coronary artery disease. It can be particularly helpful test when making a decision whether to start a statin (cholesterol lowering drug) in a patient with an intermediate risk of developing coronary artery disease.

Who should consider having a CAC score?

Individuals with an intermediate risk for heart disease are those that are likely to gain most. Intermediate risk is most often present in people over 40 years old who have one risk factor for heart disease such as high blood pressure, smoking, diabetes,  raised cholesterol, or a family history in a close relative of heart disease under 70 years of age.

CAC scoring can be extremely helpful in deciding an individual’s need for taking statins (cholesterol lowering medication).

CACS is less frequently useful for peope that either have very low risk (eg under 40 years of age) or who are already at very high risk due to having multiple risk factors such as peripheral vascular disease, diabetes, smoking and family history since these most people with such combinations will have a raised CACS. 

Who should NOT have a CAC scan?

If you are under the age of 40 it is unlikely that you have and calcification in the coronary arteries and in most cases CAC scoring is unhelpful for assessment of cardiac risk. Patients who have known coronary artery disease such as those who have previously had a heart attack, coronary stenting or a bypass do not benefit from calcium scoring. Patients with known very high risk of coronary artery disease are also likely to benefit less from the test.

Does a Calcium Score involve radiation?

Yes. The average calcium score provides about 1 millisieverts (mSv) of radiation to image the calcium in the heart arteries, this is similar to the radiation from a mammogram. The average person receives about 3 mSv in background radiation from natural sources each year. Exposure to radiation can increase one’s lifetime risk of cancer and if patients have had many x ray or CT examinations previously they might want to seek advice from their doctor prior to undergoing a CAC scan.

Can I refer myself for a CAC scan?

Not directly. All Ct scans must be requested by medically qualified professionals. However we operate a Virtual Consultation service where a self referred patient can be assessed and if appropriate referred on by our cardiologists to Heartscan direct.

Not every self-referal is suitable for a calcium score or HeartScan, so the virtual consultation collects sufficient informaton to make the process safe and complient with IR (ME) R regulations. 

 

I had CAC score years ago, is it worth having another one?

Generally speaking repeat CAC scoring is unhelpful in individuals who have previously had an elevated CAC score. This is because the previous elevated CAC score should have resulted in the necessary treatment being initiated to prevent progression of coronary artery atherosclerosis.

In people who have previously had a low CAC score who have risk factors for heart disease and are not on treatment such as statins, repeat CAC scoring after >5 years can help further risk stratification as long as the outcome of the test is likely to alter patient management.

Individuals should not generally have a repeat CAC score within 5 years.

I have regular stress ECG  tests at work, is there any point in having a CAC scan?

Yes. Stress ECGs only detect severe narrowings (>70%)  in the major blood vessels of the heart by inducing changes to the ECG under stress, triggered by lack of blood flow to the heart muscle. CAC scoring is much more sensitive, it picks up calcium deposition in the artery walls which can occur many years before coronary narrowings or heart attacks occur. CAC scoring allows for much earlier preventative action being taken which can dramatically reduce one’s risk of having a heart attack or developing a critical coronary narrowing later in life.

I feel fit and can exercise to a high degree without symptoms such a chest tightness or feeling short of breath, is there any point having a CAC scan?

Yes, there may be. If you are over 40 and have risk factors for heart disease, such as a history of elevated cholesterol, high blood pressure, diabetes, smoking, or a family history of heart disease, then CAC scoring is extremely effective at picking up early changes in the heart arteries which may not cause symptoms until years later. This allows for the early treatment and can significantly reduce one’s future risk of a heart attack or angina.

As a medical practitioner, how do I refer my patient for a CAC scan.

Direct your patient to book their own scan via our website www.heartscandirect.com or you call our office on 01483 467100

Alternatively download scan request forms or use our booking app www.scvc.co.uk/forms.

Currently we are accepting GP direct access CAC referrals but not CT coronary angiogram referrals and recommend GPs refer a patient in for assessment if you feel that they need a CT coronary angiogram.

Are there any contraindications to having a CAC scan?

Yes, CAC scanning in pregnancy is contraindicated. If you are under 40 years old then CAC scanning is often unhelpful and unless there were very specific concerns regarding one’s risk, we would not generally undertake the scan.

In patients with established coronary artery disease such as those who have had a heart attack, stenting or bypass surgery then CAC scanning does usually not offer any additional information and is thus contraindicated.

 

Where will my CAC scan be done?

Our scans are acquired using a very fast CT scanner (128 slice) that our partner company Virtual Cath Lab Surrey Ltd operates with us at 5 Huxley Road Guildford. Depending on demand and patient convenience in the future we may also be offering  our scans at other locations across Surrey.

What is the difference between a CAC scan and a CT Coronary Angiogram (CTCA)?

An Echocardiogram is an ultrasound test used to look at the heart structures including valve function. Unfortunately ultrasound does not have the ability to detect coronary artery disease or the microscopic deposits of calcium found in and around coronary vessels many years before symptoms develop. A CAC scan uses very fast x-ray to do this and conversely does not provide any information about the function of the heart and its valves. Cardiologists use both techniques in order to diagnose heart conditions in their patients.

My dad had a heart attack when he was 50 years old, should I have a CAC scan?

If you have a first degree relative (parent or child) affected where the ‘heart attack’ was a ‘coronary thrombosis’ otherwise known as myocardial Infarction or ‘MI’, then you are already at increased risk of having the same condition and should consider taking steps to reduce your risk. If you have multiple other risk factors such as smoking raised blood pressure or diabetes (all of which create a raised Q Risk) it is possible you already have such a high risk of developing heart disease that you and your GP have started a prevention programme, in which case having a CAC scan may not alter management.

 

In contrast if you have no other obvious risk factors your Q Risk will be low perhaps providing false reassurance that all is well. The CAC scan in such intermediate risk cases is very important way of finding out where you stand, and what if anything you need to do to stay healthy.

 

Is there any clinical urgency to have a CAC scan?

As long as you are not experiencing chest symptoms or angina, the timing of a CAC scan is not important as coronary heart disease takes many years to develop.

I have been getting bad chest pains when walking, should I have a CAC scan?

Anyone experiencing possible cardiac symptoms such as chest symptoms on effort may have critical coronary artery or valve narrowing that threatens life. They should see their GP or attend Hospital to see a Cardiologist without delay.  Once clinically assessed and triaged the Cardiologist may recommend a CAC scan as part of the investigation, however more often will recommend a full CT or invasive Coronary angiogram instead.

 

I feel breathless whenever I do any physical activity, should I have a CAC scan?

Breathlessness is very common and can be a presenting symptom of many conditions, including heart disease.   Although many patients we see with severe heart disease present with breathlessness instead of chest pain or angina there are multiple other causes that would NOT be detected by having a CAC scan.

 

If you are over 40 and have unusual or unexplained exertional symptoms you should therefore see your GP or one of our specialist consultants.

If I purchase a CAC scan on line what is included and what isn’t?

When purchased on line through Heartscan Direct, your fee includes a £25 non-refundable booking fee and the test fee. The test fee can be refunded if cancelled 2 weeks or more prior to the scan.

 

The scan fee includes our risk assessment (to prevent inappropriate scans or medical exposures taking place), parking, reception including tea coffee in our private consulting rooms, the scan and the CAC scan report.

 

The report sets out all you need to  know about your result and what it means.

 

The scan price does NOT include a CD or DICOM data (which can be purchased separately if required), nor does it include consultation with a Physician or Cardiologist.

Does a CAC scan predict all future heart events?

No single test can predict all future heart problems since there are many heart conditions that can be dangerous. Coronary heart disease is however one of the most common conditions affecting man and certainly one of the leading causes of preventable sudden death and shortened life span in the world.

 

If you have concerns about other heart conditions such as Cardiomyopathy or arrythmias then you should consider having our Platinum heartscreen, which includes a screening echocardiogram, exercise stress ECG, blood tests, health questionnaire and CAC score along with Cardiologist report.

I take medication, will this affect me having a CAC scan?

No, the scan can happen irrespective of medication.

I have atrial fibrillation, will this affect me having a CAC scan?

No the scan can work fine in atrial fibrillation although its best that your heart rate at rest does not exceed 100 beats per minute.

I am diabetic and take medication, will this affect me having a CAC scan?

If you are diabetic then you are already at increased risk of having the same condition and should consider taking steps to reduce your risk.

 

If you have multiple other risk factors such as smoking, raised blood pressure (all of which create a raised Q Risk) or family history  it is possible you already have such a high risk of developing heart disease that you and your GP have started a prevention programme, in which case having a CAC scan may not alter management.

 

In contrast if you have no other obvious risk factors your Q Risk will be low perhaps providing false reassurance that all is well.

 

The CAC scan in such intermediate risk cases is very important way of finding out where you stand, and what if anything you need to do to stay healthy.

I am 80 years old and feel well, is there any point having a CAC scan?

The predictive power of CAC scans is not age dependent once over 40 years of age.  If you are elderly, with life expectancy being very good, the CAC scan is highly predictive or being affected in next 10 years and might detect coronary disease that will cause a preventable heart attack.

 

Due to increased risk of heart disease with age, older patients with major coronary calcification and high CAC are at much higher risk of suffering a heart attack so may wish to know where they stand and take prevention measures if their CAC scan shows problems.

 

I am 20 years old and have heart disease running in the family, should I have a CAC scan?

Coronary calcification is rare below 40 years of age. The scan cannot be justified in younger patients.  Younger people with strong family history of coronary heart disease should take steps to protect themselves by not smoking, being physically active,  having a healthy diet and seeing their GP for a cholesterol test - since if blood cholesterol is high, they would qualify for statin therapy, even at 20 years of age.

 

I have had a coronary artery bypass surgery (CABG) in the past, should  I have a CAC scan?

Any person that has had a heart attack, angina, bypass surgery or coronary stent is already at high enough risk to have full prevention measures in place. Even the small radiation dose used in a CAC scan cannot be justified as a medical exposure to radiation and you should therefore undertake a CAC scan.  At SCVC like many cardiology clinics, we do operate stress ECG and Stress Echo testing to monitor patients with such prior heart conditions.

 

 

I have had a heart attack in the past, should I have a CAC scan?

Any person that has had a heart attack, angina, bypass surgery or coronary stent is already at high enough risk to have full prevention measures in place. Even the small radiation dose used in a CAC scan cannot be justified as a medical exposure to radiation and you should therefore NOT undertake a CAC scan.

At SCVC like many cardiology clinics, we do operate stress ECG and Stress Echo testing to monitor patients with such prior heart conditions.

What is the difference between a CAC scan (HeartScan) and a CT Coronary Angiogram (CTCA or HeartScan+)?

 

A CAC scan uses no contrast. It will not detect non calcified (so called ‘soft’) plaque disease win the coronary tree. In contrast a CT Coronary angiogram (CTCA) involves passing iodine based x-ray contrast into the heart via a vein to image the lumen or pipework of the heart.

 

Cardiologists use a combination of CAC scan and CTCA  to investigate their patients who present with symptoms of a possible heart disease.  Due to these nuances, we cannot offer CTCA scans direct to patients or most GPs.

I am, or used to be a heavy smoker, would a CAC scan look at my lungs too for early lung cancer?

Only a small part of the whole lung is looked by the CAC scan. If you have a long history of smoking there is evidence that a whole chest lung scan can detect early lung cancers and you should discuss this with your GP or contact us for advice from our chest team.

 

Occasionally we do pick up lung abnormalities during a CAC scan that will lead to recommendation for further scans, which thankfully  in over 97% of cases turn  out to be benign.

 

Refer yourself for a virtual consultation via HeartScandirect.com

You may be eligible for  a Coronary Calcium score on its own or as part of our Platinum heart screen. To find out, either call SCVC during office hours or complete our contact form using the Contact us button below.

Alternatively if you can book a cinema ticket on line, then why not try  booking a Virtual Consultation  by clicking 'book a heart scan now'?

Please note that since radiation is involved we have to check indications is appropriate so once you have scheduled your appointment you will be sent details on when and where it will take place and asked to complete our paper or online safety questionnaire required before we can confirm your appointment.

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