High Coronary Calcium Score: How do others feel emotionally?

Well....
Mayo Scottsdale is full up in cardiology and will not add me.
So....
I guess it's Cleveland.
That will make for some long travel past the virtual second opinion process.
sigh

Pete

The CT scanner is spinning, a person's heart is beating. It least in 2017, it would seem that some manufacturers of CT scanners (two out of the four tested) were creating errors of up to 50% at only 75 bpm. There was no testing past that point (errors at even higher rates). For me, my heart was readily up at 110-120 BPM, because like you, I hate being in a tube! hee hee hee
There is a body of math (Fourier) that can compensate for some motion blur, but it is not infinite. It sure would be nice of the FDA to make the manufactures certify that their CT scanners are artifact free up to a certain heart rate, and currently that is not the case.
Back in the day, when I designed, built and installed a bi-axial cardiac visualization system to image baboon hearts in motion, it required filming (yes, real film) at 400 frames per SECOND to create motion free filming of the high speed fluoroscopes used in each axis. Even then, the baboon hearts had metal markers attached to the surface of the heart to have exact registration for the motion study of heart walls.
We have much cooler stuff available now to image hearts, but from my experience I have an intuitive thought about how heart rate affects imaging. And thanks to this forum has revealed, there sure appear to be a lot of folks with monster heart scores and more healthier hearts than not. I hope I am one of them!
In any regard, I will have to be checked out by thorough imaging, and likely intra vascular. My guess is that there will be a "project" to attend to, but I am doubtful that it will be to the extent given by my CAC score.
By the way, I am grateful for all the kind responses over the weekend to my story. As this forum opened, it is an emotional journey.

My basic understanding is that CAC scoring can be accomplished with normal or even elevated heart rate as the scanning device and computer are simply counting - no "imaging."

A CT Angiogram (CT A) is to provide imaging so requires a very still heart, so most folks are given metoprolol to slow their heart rate down.

I find this very interesting although I don’t claim to understand the link you sent. What I do know is that my BP was too high initially for the scan so they gave me a beta blocker and then I went into the tube. I have slight claustrophobia but generally tolerate these types of test although not easily. I wonder if that could increase my calcium score. Is that what you think?

The paradox is that there is some evidence that statins and BP control may actually INCREASE the CAC score but also IMPROVE cardiac risk. It may be that they change the pattern of calcification to STABILISE the plaques. This is still a matter of research But don't worry. Please see my serenity prayer in my posting

Hi there sports fans with high CAC scores. This is Dr Jim member of the OMG CAC club. Thats "oh my GOD- Calcium Angotstrom Count". I am an MD though not a cardiologist and its gratifying to see all you 1000 plus persons, jogging, losing weight, controlling your blood pressure and taking your statins just like me.
Any doctor that told you the CAC score is never wrong is wrong.
Its important to know that the CAC score needs to be age adjusted i.e. If you are 50yrs old with a CAC over 500 thats very likely a problem. If you are 77 like me it may or may not be a problem. Medical Science does not yet understand the paradox of very very high CAC scores in folks who have controlled BP with beta blockers and taken their Lipitor religiously for decades like me. The calcium scan is only one of a number of risk factors that can be measured. Its not rubbish but its value may be in screening high risk high responsibility MEN like airline pilots, firefighters or astronauts. The CAC can be positive when cholesterol, EKG, ECHO and even stress tests are negative. Whats good about it is that its cheap, safe and easy to do so its a good screening test. But its just a screening test. One of many other risk factors like age, sex,lipid levels, smoking history,male pattern obesity, blood pressure and who your grandparents were. Here is a modified prayer that may help:
G-D help me to control what is in my power[ smoking, vaping,eating fast food,overeating, being a couch potato, being non-compliant and forgetting to take my medicine] and to forget about the things not in my. power [ my genetics, my sex at birth, my age, and my CAC score] and the wisdom to know the difference. If G-D cannot help there is always the MAYO CLINIC. JRM MD

@santafepete

That is a very interesting article. Thanks for providing that link. That's something they don't mention when getting the heart CT scan (and my cardiologist didn't mention that either). They do tell you to remain still, but that's about it.

If my cardiologist had said he didn't want to run any additional tests, I would have found another one. I agree you can't count on a single test for something this important.

What other alternatives are out there for lowering cholesterol? I came across PCSK9 and one other that I can't recall now. That one or PCSK9 were taken together and showed a big drop in cholesterol when used together.

Did your husband get tested for LP(a)?

We make cholesterol even if you don’t eat meat. We all need cholesterol. Some people have a predisposition to make more cholesterol. My ex husband had a heart attack at 35 and still in good health at 65. Our children were tested and my middle child is skinny , vegetarian and she makes a higher amount of cholesterol. A friend of ours had a zero calcium score but with chest pain and had other tests that showed her arteries were badly blocked and she needed bypass surgery.

I dont know if this helps you any, but I designed cardiac imaging systems for NASA back in the day, so when I see all the high CAC scores on this forum I am dubious that they are without error.
The most obvious potential error is heart rate. I know for me, my heart rate was pounding fast, as I am not a great fan of getting stuck in a tube. A lot of these CT Heart Scan imaging systems were designed for a resting heart rate of 60 bpm, with the assumption that the HR would be below 75 bpm.
My rate was like 110 to 120. I imagine others on this forum have had the same experience. Nothing was said by the radiographer at the time about my heart rate.

Here is a nice paper on CT Heart Scans and heart rate. I shared it with the group back in December:

Influence of heart rate on coronary calcium scores: a multi-manufacturer phantom study
https://link.springer.com/article/10.1007/s10554-017-1293-x
The paper was published in 2017, so a lot could have improved by now, but math can only go so far in compensating for motion artifacts. That said, they were seeing up to 50% greater scores on some CT systems due to moderately high heart rates on several brands of CT systems.

All I think it indicates is that there is a potential that there are imaging errors and that it is wise to use other imaging methods to evaluate where a person is at.

My latest experience was with a cardiologist that believed so strongly in the CAC score alone that he felt that no other imaging was necessary.

So for me, with such a high score and the possibility of error, I want imaging that will evaluate my heart condition as if CT Heart Scans didnt even exist. A completely independent view. I was greatly surprise when the cardiologist would not do so (echo with stress, nuclear with stress), and would cath me only if I insisted on it---else he would not order ANY imaging.

There are a lot of different views on diagnostics for heart disease, and then again treatment. The most conservative methods have been the use of statins on the assumption that cholesterol is the culprit, and angioplasty and stents on the mechanical side. It is a tried and true method, and it works for some people and not for others. The cardiologist I saw falls into this camp. That is ok. But his bedside manner and condescending view that all other methodologies are seriously flawed was not welcome (at least to me).

If a cardiologist is going to be poking around in my heart arteries, I am interested in intravascular lithotripsy. This uses shaped ultrasound shock waves to break up the calcium and plaque both in the artery and the wall. It is not exactly a new idea, but the ShockWave execution of the idea is novel and refined, and to me appears to work well.

The cardiologist I saw literally said IVL "its garbage!" He is entitled to his opinion, but I find hope in the technology, and there are a growing number of cardiologists that feel similar. So I will be seeking one out that shares my enthusiasm towards the technology in case I need it.

As for statins, there are a lot of great alternative medications available now that will lower cholesterol. The emerging question is what roll does inflammation have as the primary cause of heart disease, with cholesterol being an interim component of the bigger picture.

I imagine skipping forward to a nuclear perfusion test with stress is the likely first step for me. If that indicates immediate concerns, then I would like someone capable of IVL in the room if they are going to go into my arteries for a look---might as well get on with it if they see a blockage or the need for pipe cleaning.

That is my plan. I was widely taken back at the veracity of the cardiologist I met with last week. It was his way or the highway. That is ok if he feels that way, but to suggest to the patient that they should go home and live out their short life for not following their personal methods was just ridiculous.

Every one has to find something that is comfortable to their own needs. You are betting your life on it. It is a personal decision.