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Who Needs a CT Coronary Angiogram?

All About Cardiovascular System and Disorders

CT coronary angiograms are increasing in popularity as a non-invasive screening test for detecting blocks in coronary arteries. Coronary arteries are blood vessels supplying oxygenated blood to the heart. Angiograms are images of blood vessels, usually obtained by injecting medications for contrast from body structures.

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The Advantages Of A CT Coronary Angiogram

Dr. Paddy Barrett

A CTCA provides much more anatomical detail and can identify advanced plaque often missed by CT Coronary Artery Calcium Score scans alone. CT Coronary Artery Calcium Score Scan CT Coronary Artery Calcium Score CT Coronary Angiogram As you can see from the above images, the CTCA provides far more anatomical detail.

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A 50-something with Regular Wide Complex Tachycardia: What to do if electrical cardioversion does not work?

Dr. Smith's ECG Blog

Past medical history includes coronary stenting 17 years prior. If you take old people with a history of MI (he had a stent), that percentage goes far higher since there is scar tissue that acts as a nidus for the PVCs that initiate VT. Coronary angiogram shows diffuse severe three-vessel disease.

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63 year old with "good story for ACS" but negative troponins.

Dr. Smith's ECG Blog

This was texted to me from a former resident, while working at a small rural hospital, with the statement: "I can’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS." We don't know if he had a stress test, a CT Coronary angiogram, or they just decided to do an angiogram.

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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

The cardiology fellow wrote in their note “unclear etiology of troponin elevation at this time, but hypertensive emergency, underlying CAD with demand ischemia , or NSTEMI all remain on the differential… In light of his risk factors, concerning clinical presentation and troponin trend -- we favor coronary angiogram over CTCA at this time.”

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A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

Dr. Smith's ECG Blog

A CT Coronary angiogram was ordered. Here are the results: --Minimally obstructive coronary artery disease. --LAD Although a lesion is not visible anatomically on this CT scan, coronary catheter angiography could be considered based on Cardiology evaluation." A repeat troponin returned at 0.45 CAD-RADS category 1. --No

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Distractions

EMS 12-Lead

He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Learning points 1] Acute Coronary Syndrome has many shades of clinical manifestation. No appreciable skin pallor. Here is the time-zero 12 Lead ECG.