The Advantages of Cardiac Computed Tomographic Angiography
– Dr. Gerald Joyce
Cardiac Computed Tomographic Angiography (CCTA) has evolved rapidly over the last several years. With the advancement of equipment and techniques, the peer-reviewed literature has filled with articles documenting its diagnostic accuracy and its costeffectiveness. CCTA is no longer an “investigative technique.” CCTA has arrived, and is a well understood and accepted weapon in the fight against cardiac disease.
Which patients are candidates for CCTA? A paper published by a group consisting of members from eight separate medicinal societies, including the American Colleges of Cardiology and Radiology, defined the current accepted Appropriateness Criteria for CCTA. The majority of patients who are candidates for CCTA fall into one of the following categories:
- Acute chest pain syndrome, with intermediate Framingham risk criteria
- Patients with equivocal stress tests
- Suspected coronary artery anomaly
- Possible cardiac mass
Which patients are not candidates for CCTA?
- Asymptomatic patients
- Patients with acute chest pain and low or high Framingham risk criteria
- Patients with atrial fibrillation, contrast allergy, or renal insufficiency
CCTA is the only technique outside of conventional angiography that allows direct visualization of the coronary arteries. Studies confirm that CCTA is as accurate at excluding coronary artery disease (98-99%) as catheter angiography. This is done at lower risk to the patient, at a substantially lower cost, and potentially the
same or lower radiation dose as conventional angiography.
CCTA is not a test that can be performed at any CT scan facility. It is a technically demanding study to perform and interpret properly. It should be performed on a CT of 64 slice capacity or greater, and by an experienced and accredited team of technologists and physicians. All of this is available to you and your patients here at Southtowns Radiology.
Patient preparation instructions for CCTA:
- Please do not eat four hours prior to appointment.
- Please do not drink any caffeine for 24 hours prior to your appointment.
- You may drink a minimal amount of water and take prescribed medications.
- Please do not take Viagra, Cialis, or Levitra for 48 hours prior to your appointment.
- Please do not smoke the day of your appointment.
- Please do not participate in any heavy exercise before your appointment.
- Arrive 30 minutes prior to your scheduled appointment time.
- Please bring your script, insurance card, and any previous cardiac testing such as stress test, or angiogram.
- Please make sure your doctor has blood work within last six
months which must include a BUN Creatinine blood test.
What Patients Can Expect the Day of the Test:
Patients will be asked to change into a gown taking off everything from the waist up. Please, no earrings or necklaces. They will then be taken into a resting room where a nurse will insert an IV and take vital signs.
Optimal result of a CCTA exam requires that a patient’s heart rate be 50-60 beats per minute. In order to achieve this, the patient may be given a beta blocker to reduce heart rate. After they are given the medication they will rest for 30-60 minutes to allow the beta blocker to take effect. Heart rate and blood pressure will be monitored again by the nurse. If the heart rate is at the optimal rate, we will begin the test.
The technologist will take the patient into the CT room. The patient will lie on a table on their back and electrodes will be applied. Before the scan, a nitroglycerine tablet will be given. Next, contrast dye will be injected via IV. During the injection the patient may feel a warm sensation or an urge to urinate. The dye highlights blood vessels for the CCTA pictures. During the scan the patient will be asked to stop breathing (for about eight seconds) while the pictures are taken. The actual CCTA scan usually takes about 15 minutes to complete.
What to Expect After the Test:
Patients will be able to resume normal activity. They are encouraged to drink plenty of fluids throughout the day. Patient results will be forwarded to your office. Patients will then receive their results from the ordering physician.