Health Library Cardiac Calcium ScoringFrom Healthwise

Cardiac calcium scoring uses a special X-ray test called computed tomography (CT) to check for the buildup of calcium in plaque on the walls of the arteries of the heart (coronary arteries). This test is used to check for heart disease in an early stage and to determine how severe it is. Cardiac calcium scoring is also called coronary artery calcium scoring.

The coronary arteries supply blood to the heart. Normally, the coronary arteries do not contain calcium. Calcium in the coronary arteries is a sign of coronary artery disease (CAD).

A CT scan takes pictures of the heart in thin sections. The pictures are recorded in a computer and can be saved for more study or printed out as photographs.

Cardiac calcium scoring is not done very often because a physical examination and other tests often give enough information about your heart. But, if you are at medium risk for CAD based on your risk factors, cardiac calcium scoring may give your doctor more information to decide on your risk of CAD. If your doctor thinks that results from a cardiac calcium test could change your treatment for heart disease, your doctor may advise this test for you.

Cardiac calcium scoring is not advised for routine screening, because it can show that you may have plaque in your coronary arteries even if you do not have CAD. This is especially true if you have a low risk for CAD.

Cardiac calcium scoring is done to:

• Find out if you have coronary artery disease (CAD).
• Find out how severe your heart disease is.
• Sometimes predict if you will get symptoms of CAD.

You do not need to do anything before you have this test.

You probably will not have this test if you have had a heart attack, coronary artery bypass surgery (CABG), or angioplasty. Also, the test usually is not for women who are or might be pregnant.

Talk to your health professional about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will indicate. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

A cardiac calcium scoring test is usually done by a radiology technologist. The pictures are usually interpreted by a radiologist. Other doctors, such as a family medicine doctor, internist, cardiologist, or surgeon, may also review a cardiac calcium scoring test.

You will need to remove any jewelry that might be in the way of the X-ray picture. You may need to take off some of your clothes. If so, you will be given a gown to use during the test. For some CT scans, you may be able to wear your clothes. If so, wear loose clothes that do not have zippers or snaps.

Small metal discs called electrodes will be put on your chest. Wires connect these to an EKG machine that records the electrical activity of your heart on paper. The EKG records when your heart is in the resting stage, which is the best time for the CT scans to be taken.

If your heart rate is 90 beats per minute or higher, you may be given medicine to slow your heart rate.

During the test, you will lie on a table connected to the CT scanner. The scanner is a large doughnut-shaped machine.

The table slides into the round opening of the machine and the scanner moves around your body. The table will move a little every few seconds to take new pictures. You may hear clicking or buzzing sounds as the table and scanner move.

You may be asked to hold your breath for 20 to 30 seconds while about 200 pictures of your heart are taken. It is very important to hold completely still while the pictures are taken.

During the test, you are usually alone in the scanner room. However, the technologist will watch you through a window. You will be able to talk with the technologist through a two-way intercom.

A cardiac calcium scoring test takes about 30 minutes.

You won't have any pain from the X-rays during the cardiac calcium scoring test. However, the table you lie on may feel hard and the room may be cool. You may find it hard to lie in one position for a long time.

Some people feel nervous or claustrophobic while inside the CT scanner. If this keeps you from lying still in the scanner, you may be given a drug (sedative) to help you relax.

There is always a slight risk from being exposed to any radiation, including the low levels used for a CT scan.

Cardiac calcium scoring uses a special X-ray test called computed tomography (CT) to check for the buildup of calcium in plaque on the walls of the arteries of the heart (coronary arteries). The radiologist may discuss initial results of the cardiac calcium scoring test with you right after the test.

High values

The higher your score on cardiac calcium scoring, the more plaque you have in the arteries of your heart. This makes your chance of having a heart attack higher.

If you have a high cardiac calcium score, you may need more tests to check if you have coronary artery disease (CAD) or to find out how severe it is, especially if you have other risk factors for CAD. Cardiac calcium scoring can show that you may have plaque in your coronary arteries even if you do not have CAD. So this test is not advised for routine screening for coronary artery disease.

Reasons you may not be able to have the test or why the results may not be helpful include:

• Having a fast heart rate, such as atrial fibrillation.
• Smoking.
• Caffeine use.

• Plaque that is not hard (soft plaque) cannot be found with cardiac calcium scoring. Soft plaque is the earliest form of damage to the arteries of the heart. If you have soft plaque in your arteries, the test may give normal results, but this is a false-negative result. The buildup of soft plaque can also cause a heart attack.
• Cardiac calcium scoring is not done very often because a physical examination and other tests can give information about your heart. This test may be recommended for men age 45 and older and women age 55 and older who have a higher chance of heart disease. Younger adults may be tested if they have a very strong family history of heart disease.
• If your cardiac calcium scoring shows that you have a high chance of having heart disease, you can take steps to lower your chance. Eat better, quit smoking, and get more exercise. These are the same steps your doctor would recommend after looking at your health history, your physical health, and any lab tests, such as a cholesterol test. If you have high blood pressure or high cholesterol, talk to your health professional about your treatment choices.
• If you have an irregular heartbeat (arrhythmia) or a heart rate higher than 90 beats per minute, you may need to take a medicine before this test to slow your heart rate.
• It is possible to have false-positive test results. This means that the test shows a high chance of blockage in the arteries of the heart when it is not true. People with a low chance of heart disease are most likely to have a false-positive test. This test is not advised for routine screening for coronary artery disease.
• Cardiac calcium scoring may not be covered by all health insurance plans.
• Cardiac calcium scoring may not be available in some areas of the United States, such as in small towns.

Other Works Consulted

• Hoffmann U, et al. (2003). Use of new imaging techniques to screen for coronary artery disease. Circulation, 108(8): e50–e53.

• Mahmarian JJ (2004). Computed tomography of the heart. In V Fuster et al., eds., Hurst's The Heart, 11th ed., pp. 599–627. New York: McGraw-Hill.

Author:	Maria G. Essig, MS, ELS	Last Updated: June 19, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine George Philippides, MD - Cardiology
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