Coronary Calcium Score

Are you concerned about the possibility of having coronary artery disease or coronary plaque buildup? The preferred diagnostic test is a coronary calcium score, not a stress test. Coronary Artery Calcification (CAC) is a measure of atherosclerosis. We start developing atherosclerosis around 18-19 years of age as per studies done on casualties during the Vietnam War. The development of Coronary Artery Disease (CAD) is a lifelong process, the severity of which varies depending on genetic and environmental factors.

The process starts when a small fat (lipid) particle penetrates the lining of the coronary artery. A type of white blood cell, part of the immune system, responsible for finding and destroying infections called monocytes enters the area and starts digesting the lipid particle. This initiates an immune response with atheroma being formed. With time, additional inflammatory cells and immune components are attracted to the area, and the inflammatory process continues with the formation of micro and macro calcifications and the plaque gets larger.

It's during the formation of coronary plaque before the plaque has matured, calcified, and stabilized that plaque rupture can occur. This calcified, hard plaque ruptures less often than a plaque that is still evolving. Think of a coronary plaque as a small volcano growing in the lumen of the coronary artery. Depending on the size of the plaque, it can reduce blood flow leading to angina symptoms. Most commonly, however, is erosion or rupture of the cap or surface of the plaque which leads to an acute coronary event including a heart attack.

This happens when the release of the inflammatory and immune cells in the plaque triggers the body to try to limit this by forming a blood clot or thrombus in the area of the rupture which tends to cause a complete blockage of blood flow in the artery leading to the heart attack. Soft, non-calcified plaques still in development are usually the ones that erode or rupture leading to heart attacks and acute coronary syndromes. We can assume the amount of soft plaques present in the coronary artery by the amount or severity of the calcified plaque seen by the coronary calcium score.

A stress test does not allow us to see coronary plaques. A stress test only shows if there is a decreased blood flow in the coronary artery. It's a test of coronary blood flow and physiology. You can have a normal stress test one day and a day or two later, have a heart attack. A coronary calcium score is a plain, non-contrast CT scan of the coronary arteries that takes about 90 seconds. It's a test of anatomy, allowing the specialist to see the location and severity of the coronary plaque. Anyone without chest pain symptoms and who has risk factors for coronary artery disease should ask their doctor for a coronary calcium score. A simple, quick, noninvasive test can help with your cardiac management.