Cardiac scoring gives measure of heart risks

This article submitted by Michael Jacobson on 2/28/01.

The way Terry Anderson figures it, having cardiac scoring done at the Paynesville Area Health Care System gave him more time for corrective measures.

Anderson lives in Litchfield but is a patient of Dr. Tom Sult at the Integrated Health Center. Anderson runs around 400 miles a year, eats whole foods and dietary supplements, and undergoes preventative chelation treatments.

But when he found he had elevated levels of the bad kinds of cholesterol, Anderson decided to follow a friend in getting his cardiac scoring done on PAHCS's state-of-the-art CT scanner.

"I figure, "Hey, it's noninvasive. I might as well see what it is," said Anderson.

He had more blockage in his coronary arteries than is normal for his age. "It's not a horrific score," he explained, "but on the other hand, I do have some risk."

Helping patients like Anderson discover this risk is exactly why Sult pushed for PAHCS to acquire the new scanner a year ago. The first symptom of coronary disease in half the patients is a heart attack, Sult explains. Half of these people die, meaning a quarter of the people suddenly die as an initial sign of coronary disease.

These people have no chance for corrective measures that would reduce the blockages in their arteries, no warning to change their ways to healthier living. "The problem," explained Dr. Sult, "is you don't have symptoms until at least a half of the artery is blocked."

Its noninvasive nature makes cardiac scoring a good preventative tool. It doesn't require a medical procedure like angiography, only a half-hour appointment in the radiology department and a few minute scan.

Patients can request to have one, and learn the condition of their coronary arteries compared to their peers in age.

Anderson, who has practiced various types of alternative medicine on and off for 30 years, wouldn't consider undergoing an invasive procedure like angiography, or invasive treatments like angioplasty and bypass surgery. For him, the scan was the only way to learn about the blockage in his arteries. And it gives him extra time, for medicine, for exercise, for eating right, to reverse the course of the disease. He plans to have his cardiac scoring done every year. "I figure I'll do that once a year to see if there's any improvement or deterioration," he said. "Cardiologists would dispute this, but I think this is the most important development since bypass surgery," said Dr. Sult of cardiac scoring's effect on coronary medicine.

Its noninvasiveness helps cardiac scoring be done to more people. Right now, the radiology department is doing a side-by-side study of virtual colonoscopies versus real colonoscopies, with the hope that a virtual colonoscopy could also be used as a screening tool.

Many people have an aversion to a real colonoscopy, and doing a virtual one, when a real one would be rejected, makes it a potentially powerful tool, said Mark Dingmann, PAHCS radiology manager.

Everyone knows that fatty foods, like French fries, are bad for you, and that eating vegetables and exercise is good for you. But changing to a healthier lifestyle can be difficult.

The pictures that the CT scanner provides can help give patients inspiration to change their ways, according to Dingmann and Troy Mansell, CT specialist.

Pictures, it seems, are worth a thousand words in showing patients the blockages in their blood vessels. "The big thing about it is we can show them," said Mansell. "It really does make a big difference."

"If you can catch it at the early stages, before it does any harm," said Dingmann, "the success rate goes up immensely."

In mild cases, a high score leads only to lifestyle modifications, perhaps some medications, and certainly continued monitoring. In more severe cases, immediate follow-up is required, possibly angiography, angioplasty, or even bypass surgery.

The body uses cholesterol to repair the arteries from damage, but over time the cholesterol hardens into calcium, said Dr. Sult. This builds up to block the arteries around the heart. When the blood flow to the heart itself becomes insufficient for the heart to keep beating, a heart attack follows.

The scan for cardiac scoring is done in three stages. The first two scans scout the location of the heart in the patient's body, both horizontally and vertically.

Then a series of 14 scans are done through the heart. Patients are hooked up to an EKG, which monitors the heart's beating and triggers the scan when the heart is at rest.

On the scan, the heart appears grey as it is made of muscle, and the calcium in the arteries is white, like bone. The radiologist staff must review the scan, identify the arteries in each shot, and help the computer derive a composite pictures of the arteries.

The scans must also be reviewed by a radiologist to look for any other abnormalities. Gall stones, cysts, and cancerous tumors have been discovered by the scan for cardiac scoring.

From the composite picture, the amount of calcification in the blood vessels is measured, and then patients are compared against people their age based on risk factors: such as smoking, obesity, high cholesterol, diabetes, and family history.

A high score is not a guarantee of heart disease, but it does indicate increased risk.

One of four
The state-of-the-art scanner that allows PAHCS to offer cardiac scoring is one of only four in the state, and the only one in outstate Minnesota. It arrived just over ten months ago.

After a survey period in April, cardiac scoring got under way in May. "After that, we were flying," said Dingmann.

At first only two radiology staff members knew the procedure for cardiac scoring, but now five people can do them. The department does, on average, 24 cardiac scores per month, according to Dingmann, which works out to about one per work day.

The cost of cardiac scoring is $395 at PAHCS, which is $100 less than at Abbott Northwestern and the Mayo Clinic, said Dingmann.

Some insurance companies will cover the test. "Even if people come in and self pay, we ask that they submit it to insurance," said Mansell, "and some of them are getting reimbursed."

In the ten months prior to the arrival of the new scanner, the radiology department did 758 CT scans. In the ten months since, they have done 1,275. This is nearly a 40 percent increase, which means that more patients, like Anderson, are opting to get screened while they still have time for remedy.

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