Stress Test Gives Best Evaluation of Cardiac Risks

Q:  Please help us. My husband and I had heart scans recently. Although my cardiac calcification score was 0, my husband's was 1,049, and the heart scan report said that any score higher than 1,000 meant "a severe identifiable plaque: high likelihood of significant stenosis of more than one coronary vessel."

Our doctor told us not to worry. I know that calcifications are a sign of hardening of the arteries. How can he get rid of the calcifications? Should he see a heart specialist?

A:  Hardened arteries truly are hardened by calcium, usually deposited in a cholesterol "plaque." Severely affected arteries are also narrowed (a "stenosis") so that the blood supply to the heart is limited. Inadequate blood flow to the heart can cause chest pain, or angina, while a disruption of the hardened plaque can cause a heart attack. So you are right to be concerned about calcifications, but what we need to know is whether the calcifications are concentrated in one vessel, putting your husband at risk for angina or a heart attack, or whether the calcifications are spread out evenly about the heart and have no clinical significance.

The standard way to diagnose narrowed arteries and to assess risk for a heart attack is with a stress test, and your husband should certainly talk to either his primary care doctor or a heart specialist about whether a stress test is warranted. This decision will depend on any symptoms or other medical problems he may have. Heart disease and calcifications can be lessened by stopping smoking, controlling blood pressure, cholesterol and diabetes, and maintaining normal weight.

I asked David Rutlen, MD, FACP, FACC, Professor of Cardiovascular Medicine and Director of the Froedtert & Medical College Cardiovascular Medicine Clinic, about the role of heart scans. He said a high calcium score does predict angina, but it may be no more predictive than what we already know from the well-recognized risk factors of increased age, hypertension, elevated cholesterol level, smoking, diabetes and family history of early heart disease.

In our quest to stay healthy, we are sometimes tempted to undergo tests to "just make sure" we are indeed healthy. Mobile CAT scan units, with their promise of "new technology" prey on these vulnerabilities and charge $200 for each heart scan, chest scan or abdomen scan, a price not generally covered by insurance.

It is reassuring to have a normal test, but an "abnormal" test does not mean illness, nor can injudicious testing ward off a medical tragedy. The best preventive care may still be a visit to a doctor to discuss a healthy lifestyle.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic – East. Her column also appears in the Milwaukee Journal-Sentinel.