Re: both ct scan and thallium stress test?

In article <n4b2k2ljdkc4j1rq1q7burp04plah5u42f@xxxxxxx>,
Jim Chinnis <jchinnis@xxxxxxxxxxxxxxxx> wrote:

"mdb" <milo_dhuey@xxxxxxxxx> wrote in part:

My cardiologist has recommended that I have both a thallium stress test and
a CT scan of the heart, to rule out any heart problems for me. The reason
for the tests is that my brother, 3 yrs older than me at 58, recently had a
heart attack and subsequently had triple bypass surgery. It seems to me that
the CT scan would give a better answer about possible calcification and
would eliminate the need for the stress test. I'm trying to keep costs down
while still getting an accurate picture of my heart. Does anyone know if
both tests really are necessary?

thanks.

Michael


The ct scan shows only calcified plaque. The thallium test can detect
uncalcified (and probably more dangerous) plaque. I think that sometimes the
ct is done first. if it is really clear, there may be little probability of
major plaque buildup that the thallium would detect. The combination of
tests definitely gives a better picture than either alone.
--
Jim Chinnis Warrenton, Virginia, USA


The thallium will detect a reduction of flow and is a functional test
(it is reporting reduction in flow and does not really distinguish
vulnerable from non vulnerable plaque). Only IVUS will report
vulnerable plaque. Unfortunately, you need the reduction in flow to be
quite significant for it to show up in the thalium stress test.

The cardiologist is proposing a test that could detect low levels of
calcified plaque and a functional test that would be sensitive to
significant blockage. If you have led anywhere close to a normal
American life it is a fairly good bet that you have some degree of
coronary artery disease (and will score positive on the calcium
scoring). As Jim pointed out, the calcified plaque is generally more
likely to cause angina and physical discomfort rather than sudden death
or MI which vulnerable soft non-calcified plaque will cause.

At the current moment in time, none of the non-invasive tests are all
that great. They are simply so so screening tools that will stratify
your risk for more definitive but unfortunately considerably more
expensive and risky invasive tests. You simply have to accept that.
Given the fact that the non invasive diagnostics are crappy, I would be
biased towards medical intervention at the smallest anomaly (bad lipids,
blood pressure etc.).


Consider popping a baby asprin if you are not already doing it and it
is not contraindicated for you based on any other medications you are
taking.

Roland
.

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