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What Causes An Increased Calcification Score For Left Anterior Descending Coronary Artery?
Question: I had a Calcium Scoring test last week & am surprised and concerned about the results. I’m a healthy 66 yr old tall, thin, active female, no diabetes, never smoked, typical BP 126-134/80-85, diagnosed 2006 with “very mild” MR and Tricuspid regurgitation. No known Hx of rheumatic fever. Regurg. unchanged over 3 cardiac echos in 7 years. No treatment and D/c’d from cardiologist in 2012. About twice a year I wake in early morn hours (2-4a.m.) with substernal pain and jaw pain that lasts at most 10 minutes or less, sometimes radiating to my back. I take 2 Tums which seems to get rid of it – or it goes away on its own and the Tums are just coincidental to it. No SOB with routine activities like 2 mi.on Nordic Track or brisk walk. I have random occasional palpatations and a few missed/irregular beats.
I take one Rx - 100 mg q day of Elmiron (has heparin-like blood effects) for Interstitial Cystitis. I take 500mg Mg oxide @ H.S. for IBS-constipation.
My father had an M.I. and cardiac arrest in XXXXXXX lab at age 78- and lived to be 95.
My lipid panel in November: LDL 128; HDL 93; Trigylc 67. I have always had high HDL and low triglycerides.
Cal. Score Result = zero in LM, RCA, & CX; 236, & volume 177 in LAD. Small pericardial effusion seen, up to 8 mm in some areas but thinner along most of pericardium.
A – 2 to 3 mm pulmonary nodule was found on lateral aspect left lung. Radiologist report advised no F/up for this size nodule as I am not a smoker. No regular exposure to 2nd hand smoke since age 35. Report does not say if nodule looks calcified or spiculated. Recent URI with viral bronchitis is mostly resolved after 2 moht of cough – could nodule be from that infection?
How concerned should I be about this pulmonary nodule and do you agree with radiologist recommendation of no f/up?
How significant is the pericardial effusion and can a leaky valve cause that? How do I know if my LAD calcification is stable? The CT report does not tell me where along the LAD the calcification is. If I have CAD then why is only the LAD affected / calcified? I hate taking meds and am very self-motivated to exercise and already restrict my diet, and do not want to have a cardiac catheterization. Do I need to restrict my low fat dietary calcium? How significant is this LAD calcification? - Do I need a stress test? What follow-up or treatment do you recommend?
I take one Rx - 100 mg q day of Elmiron (has heparin-like blood effects) for Interstitial Cystitis. I take 500mg Mg oxide @ H.S. for IBS-constipation.
My father had an M.I. and cardiac arrest in XXXXXXX lab at age 78- and lived to be 95.
My lipid panel in November: LDL 128; HDL 93; Trigylc 67. I have always had high HDL and low triglycerides.
Cal. Score Result = zero in LM, RCA, & CX; 236, & volume 177 in LAD. Small pericardial effusion seen, up to 8 mm in some areas but thinner along most of pericardium.
A – 2 to 3 mm pulmonary nodule was found on lateral aspect left lung. Radiologist report advised no F/up for this size nodule as I am not a smoker. No regular exposure to 2nd hand smoke since age 35. Report does not say if nodule looks calcified or spiculated. Recent URI with viral bronchitis is mostly resolved after 2 moht of cough – could nodule be from that infection?
How concerned should I be about this pulmonary nodule and do you agree with radiologist recommendation of no f/up?
How significant is the pericardial effusion and can a leaky valve cause that? How do I know if my LAD calcification is stable? The CT report does not tell me where along the LAD the calcification is. If I have CAD then why is only the LAD affected / calcified? I hate taking meds and am very self-motivated to exercise and already restrict my diet, and do not want to have a cardiac catheterization. Do I need to restrict my low fat dietary calcium? How significant is this LAD calcification? - Do I need a stress test? What follow-up or treatment do you recommend?
Brief Answer:
I have some suggestions for you.
Detailed Answer:
Hello!
Thank you for asking on HCM!
I passed carefully through your medical history, and would like to explain my opinion as follows:
(1) Regarding that pulmonary nodule, the most important clue is to follow up its possible rate of progression. Pulmonary nodules are one of the most challenging pulmonary diagnoses. A meticulous differential diagnosis is required. It is true that such a small nodule is not actually supposed dangerous. But we have to be cautious in drawing preliminary conclusions. I would recommend a scheduled follow up. You have to talk with a pulmonologist about that issue.
(2) Regarding pericardial effusion it is a small one, without actually any clinically significant risks. I would like to assure you, that your mitral and tricuspid valves seems to be normally functioning (very mild regurgitation is a normal finding -as the nature is not so perfect in doing things), and they have nothing to do with your pericardial effusion. My advice on that issue (effusion) is periodically follow ups by cardiac ultrasound for the fluid amount quantification. If possible, a differential diagnosis should be done to define the probably identifiable etiology of that effusion (it is sometimes an overwhelming process, including many body systems investigation - in fact, a diagnosis by exclusion).
(3) Regarding your calcium score index, I would explain that is is classified as an increased calcification score for LAD. Remember that coronary CT scan is not considered the gold standard for CAD; it is a good option for intermediate risk patients. A low calcium score does not exclude an existing important coronary disease. Only coronary angiography will rule out CAD. As it doesn't seem to be a pleasant option for you, a rationale test would be a nuclear stress test (cardiolite), which may show potential myocardial ischemia in LAD supplied territories. You just have to talk with your cardiologist about that option.
(4) There is no need to restrict you diary calcium.
(5) Traditional exercise stress tests, as scheduled by your attending physician would be a rationale follow up option.
(6) Just keep on healthy diet, and lipid lowering therapy, as well as a healthy life style.
Hope to have been helpful to you.
Feel free to ask me whenever you need. Greetings! Dr. Iliri
I have some suggestions for you.
Detailed Answer:
Hello!
Thank you for asking on HCM!
I passed carefully through your medical history, and would like to explain my opinion as follows:
(1) Regarding that pulmonary nodule, the most important clue is to follow up its possible rate of progression. Pulmonary nodules are one of the most challenging pulmonary diagnoses. A meticulous differential diagnosis is required. It is true that such a small nodule is not actually supposed dangerous. But we have to be cautious in drawing preliminary conclusions. I would recommend a scheduled follow up. You have to talk with a pulmonologist about that issue.
(2) Regarding pericardial effusion it is a small one, without actually any clinically significant risks. I would like to assure you, that your mitral and tricuspid valves seems to be normally functioning (very mild regurgitation is a normal finding -as the nature is not so perfect in doing things), and they have nothing to do with your pericardial effusion. My advice on that issue (effusion) is periodically follow ups by cardiac ultrasound for the fluid amount quantification. If possible, a differential diagnosis should be done to define the probably identifiable etiology of that effusion (it is sometimes an overwhelming process, including many body systems investigation - in fact, a diagnosis by exclusion).
(3) Regarding your calcium score index, I would explain that is is classified as an increased calcification score for LAD. Remember that coronary CT scan is not considered the gold standard for CAD; it is a good option for intermediate risk patients. A low calcium score does not exclude an existing important coronary disease. Only coronary angiography will rule out CAD. As it doesn't seem to be a pleasant option for you, a rationale test would be a nuclear stress test (cardiolite), which may show potential myocardial ischemia in LAD supplied territories. You just have to talk with your cardiologist about that option.
(4) There is no need to restrict you diary calcium.
(5) Traditional exercise stress tests, as scheduled by your attending physician would be a rationale follow up option.
(6) Just keep on healthy diet, and lipid lowering therapy, as well as a healthy life style.
Hope to have been helpful to you.
Feel free to ask me whenever you need. Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dr. Ilir Sharka,
Thank you for your response to my question. I need some clarification on your #3 answer regarding my calcium score. You mention "A low calcium score does not exclude an existing important coronary disease."
Does that mean that even though my score is zero in all other coronary arteries - except the LAD - I could still have CAD in some of those arteries? And if so - why does my calcium score show up as zero in those arteries?
Thank you for your response to my question. I need some clarification on your #3 answer regarding my calcium score. You mention "A low calcium score does not exclude an existing important coronary disease."
Does that mean that even though my score is zero in all other coronary arteries - except the LAD - I could still have CAD in some of those arteries? And if so - why does my calcium score show up as zero in those arteries?
Brief Answer:
I would explain following clues about your calcium score.
Detailed Answer:
Hello again!
Facing your interest on coronary angio CT results, I would like to explain as follows:
Coronary CT in a very helpful tool for screening, and helping in the differential diagnosis of chest pain patients, stratified as intermediate coronary risk profile.
It's accuracy yields unsatisfactory results, when the patient is on very low risk profile for CAD (no known coronary risk factors, no actual clinical symptoms), as well as in high risk patients (known and multiple coronary risk patients, overt cardiac ischemic symptoms).
Calcium score index is used to identify patients with a high coronary calcium burden, that are more likely to have coronary atherosclerotic lesions (as a considerable amount of stable and chronic atherosclerotic plaques are calcified).
From the other part, a high calcium score index should be investigated further with other additional tests, to clarify the clinical significance of potential coronary stenosis.
But, calcium index lacks information about soft lipid core calcium-free plaques.
That is the reason, why calcium score index shows low sensibility and specificity when dealing with concrete coronary lesions. If coronary angio CT doesn't refer topical concrete stenosis, then you need additional tests to conclude CAD existence.
Returning to your last questions, I would explain that a calcium score of zero excludes with a high probability chronic calcified atherosclerotic plaques on those arteries, and hence, as you are free of clinical symptoms, excludes clinically important coronary stenosis in those arteries.
You have to relax, when facing with a calcium score of zero. Regarding LAD, remains to be clarified with some additional tests, like I mentioned you above nuclear imagine stress test (cardiolite), possible ischemia signs in territories supplied by that artery.
Traditional exercise stress testing is also considered a practical option.
If myocardial ischemia is confirmed by those tests, then a coronary angiography would be the next recommended diagnostic step.
Hope that all the above paragraphs will be helpful to you.
Best Regards! Dr. Iliri
I would explain following clues about your calcium score.
Detailed Answer:
Hello again!
Facing your interest on coronary angio CT results, I would like to explain as follows:
Coronary CT in a very helpful tool for screening, and helping in the differential diagnosis of chest pain patients, stratified as intermediate coronary risk profile.
It's accuracy yields unsatisfactory results, when the patient is on very low risk profile for CAD (no known coronary risk factors, no actual clinical symptoms), as well as in high risk patients (known and multiple coronary risk patients, overt cardiac ischemic symptoms).
Calcium score index is used to identify patients with a high coronary calcium burden, that are more likely to have coronary atherosclerotic lesions (as a considerable amount of stable and chronic atherosclerotic plaques are calcified).
From the other part, a high calcium score index should be investigated further with other additional tests, to clarify the clinical significance of potential coronary stenosis.
But, calcium index lacks information about soft lipid core calcium-free plaques.
That is the reason, why calcium score index shows low sensibility and specificity when dealing with concrete coronary lesions. If coronary angio CT doesn't refer topical concrete stenosis, then you need additional tests to conclude CAD existence.
Returning to your last questions, I would explain that a calcium score of zero excludes with a high probability chronic calcified atherosclerotic plaques on those arteries, and hence, as you are free of clinical symptoms, excludes clinically important coronary stenosis in those arteries.
You have to relax, when facing with a calcium score of zero. Regarding LAD, remains to be clarified with some additional tests, like I mentioned you above nuclear imagine stress test (cardiolite), possible ischemia signs in territories supplied by that artery.
Traditional exercise stress testing is also considered a practical option.
If myocardial ischemia is confirmed by those tests, then a coronary angiography would be the next recommended diagnostic step.
Hope that all the above paragraphs will be helpful to you.
Best Regards! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your very helpful and excellent explanation and information.
Brief Answer:
You are welcome!
Detailed Answer:
You are welcome!
You are welcome!
Detailed Answer:
You are welcome!
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
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