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Chat overview with Dr. Campbell – February 7, 2006
CTA is a new diagnostic tool to evaluate noninvasively for coronary artery disease. We can detect blockages much sooner and great accuracy. The test takes 15 seconds to perform. It allows us to look at the walls of the artery, which is where plaque or blockage first develops. This is not possible with other diagnostic tools.
Q. Do I have to stay in the hospital for this procedure?
A. No. This is an outpatient test. Total time from coming in to going home is less than 1 hour. Images are available for viewing 5-10 minutes after the exam. The exam not only includes findings of your heart arteries and chamber sizes, it also includes an evaluation of lung tissue, which is interpreted by radiologists. In our 150 cases, we have found 2 spots that appeared to be lung tumors.
Q. How long before the results are conveyed to the patient?
A. We can let the patient know the results within 15 minutes of the exam. We also review the exam with the patients. The patients will view this on the computer monitors.
Q. Should I have this test if I have a family history or if I have had problems in the past.
A. Men over age 40, woman over age 50, should consider this exam if strong family history. If you have had heart problems in the past, this exam can add more information to your other studies.
Q. Is a doctor's referral necessary?
A. No. A doctor needs to order the exam; however, a physician's referral to cardiology is not required.
Q. Is there a certain age recommended for the CTA....if no family history of heart disease?
A. There is no certain age. The more risk factors, such as diabetes, smoking, hypertension, high cholesterol, the sooner I would recommend the exam. This may mean some in their 30's should be evaluated, and others may wait until their 50-60's.
Q. Is this a test that I would have performed routinely, say every few years if over 50?
A. Maybe every 5 years, not every few years.
Q. Are there any risks associated with the exam?
A. The exam involves contrast, so if there is a dye allergy, you need to be pretreated. The exam also exposes you to some radiation. The risk would be very similar to a CAT scan of your chest.
Q. Is there anyone who should not have this exam?
A. Those with irregular heart rhythms, such as atrial fibrillation, severely obese, or severe claustrophobia should not have the exam.
Q. Do you know the cost of the exam?
A. The exam costs $700.00. That cost includes the exam itself, the cardiology interpretation of your heart arteries and heart structures, as well as the radiologist's interpretation of the remainder of lungs and chest.
Q. And how does that compare price-wise with other diagnostic tests?
A. Stress echo is about $500.00, stress nuclear is $2,000.00, and a heart catheterization is about $8,000.00. The accuracy of CTA is equivalent to catheterization and provides more information about the walls of the artery which is where the plaque is locate
Q. Is there anything you typically see on the exam of a person who has diabetes?
A. Diabetics typically have plaque much earlier and tend to have more diffuse disease or blockage.
Q. More diffuse---does that mean more widespread?
A. Yes.
Q. Does this exam take the place of an angiogram?
A. It can take the place of an angiogram. Up to 40% of all heart catheterizations are normal. The goal is to use CTA to replace angiograms in those patients, so as to help cut costs, but maintain accuracy and early diagnosis.
Q. So as a diagnostic tool, CTA sounds pretty beneficial. Does it change your protocols -- given what you can see?
A. Yes; we can see plaque much earlier and frequently more definitively than with standard angiograms. Also, we are able to do this noninvasively and cheaper.
Q. Do you think it will be long before insurance companies will pay for this?
A. Unfortunately, until insurance coverage is more widespread, we are sometimes forced to do invasive procedures when CTA would be beneficial.
Q. My dad was just diagnosed with hardening of the arteries, should he have this test done?
A. It depends on the severity of his diagnosis; it is too hard to say with just this information. If he is older than 70 and already been diagnosed, this exam may not add a lot of information.
Q. Is the exam cost covered by regular health insurance and/or medicare?
A. John Deere will cover this exam with prior approval and Medicare approves it only in South Carolina, New York and New Jersey. We expect, in the future, all insurance carriers and Medicare to cover it; however, this could take a few years.
Q. How long has the CTA scan been offered at Mercy and do other hospitals have it yet?
A. Mercy has been doing it since May of 2005. We have done 150 scans. The University offers the exam on a 16-slice machine, and, I believe, Mercy in Cedar Rapids plans to start on a 64-slice machine. Currently, we were the first to offer this exam. We also have the most experience within the state and will soon be credentialed to teach other physicians how to interpret the exams.
Q. Can this exam look at the heart valves or any problems there?
A. Yes. We see not only the heart arteries, we see heart chamber sizes, heart muscle thickness, all the valves, heart muscle function and the sac around the heart (or pericardium).
Q. Does the patient have to do anything special to prepare for the exam?
A. The heart rate needs to be less than 70 and may require medication, and the patient will need an IV started before the exam to give contrast material, and the patient will have to hold their breath 15 seconds during the scan.
Q. Can exercise reduce plaque deposits that are already there?
A. Yes, it can. Also, exercise can help stabilize the plaques, so that they are less apt to rupture and cause heart attacks.
Q. Can I ask a question on a slightly different topic? What do you think of diets like Atkins?
A. Moderation is the key to life. Any diet that is not broad-based or highly restrictive is probably not beneficial in the long run. Although, you lose weight with Atkins, many times I have seen patients put it right back on. I believe that is why diet fads tend to come and go. A well balanced diet based upon moderation is key.
Q. My grandmother just had a stint put in....what is that and what does it do?
A. A stent is a metal mesh tube that looks like a spring and a ballpoint pen. The stent opens up a blocked artery and helps it to stay open. A balloon is used to expand the stent into position.
Q. I recall from your presentation that someone with a stent is not a good candidate for CTA. Is that correct?
A. You are correct. It is difficult to look inside a stent with CTA. A recent publication showed accuracy of approximately 80%. We would like to see that closer to 97%.
Q. Who do I contact if I would like to schedule a CTA scan?
A. You may call our office at 319-339-3883 and ask to schedule a CTA consult. You will see either myself or Dr. Lee.
Q. I have been drinking pomegranate juice for several months and really think it has really helped, but now my A1C has jumped up. Any comment?
A. There are indeed a lot of benefits to pomegranate juice. If the pomegranate juice is sweetened this could explain your increased hemoglobin A1c.
Q. What are the benefits of pomegranate juice?
A. It is an antioxidant which helps bad cholesterol from being deposited in the artery walls. It also helps with prostate enlargement, and it is a great way to eat funny looking fruit!
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