What are the application areas of coronary CT angiography?
Cardiac tomography/Coronary CT angiography guides the treatment of many heart diseases such as coronary artery disease, pericardium diseases, congenital (congenital) heart diseases, heart masses, valve and prosthetic valve diseases.
With the coronary CT angiography method, also known as ‘virtual angiography’ among the people, the calcium, calcification levels in the patient’s vessels can be checked and the stenosis caused by these can be clearly evaluated. Although the calcium score is a very important marker, it is not directly related to the severity of coronary artery disease. Sometimes, although there is calcium in the veins, there is no serious stenosis, while patients with a zero calcium score, that is, no calcification in their veins, may also have plaques called soft plaques, and these plaques can even cause serious stenosis.
Contents
What is cardiac tomography/coronary CT angiography?
What are the application areas of cardiac tomography/coronary CT angiography? In which diseases is it used?
What are the distinctive features/advantages of cardiac tomography/coronary CT angiography?
What is the process of cardiac tomography/coronary CT angiography?
Frequently asked questions about cardiac tomography
What are the disadvantages of cardiac tomography/coronary CT angiography?
What is cardiac tomography/coronary CT angiography?
Cardiac tomography/Coronary CT angiography is a tomographic imaging method using contrast media, which is used as a guide in the evaluation of anatomical disorders of the heart, especially in the coronary arteries, and in the treatment planning of many heart diseases.
What are the application areas of cardiac tomography/coronary CT angiography? In which diseases is it used?
Cardiac tomography/Coronary CT angiography guides the treatment of many heart diseases such as coronary artery disease, pericardium diseases, congenital (congenital) heart diseases, heart masses, valve and prosthetic valve diseases.
What are the distinctive features/advantages of cardiac tomography/coronary CT angiography?
When a successful acquisition with coronary CT angiography is performed, a highly informative image can be obtained almost as in angiography. In fact, while only the inside of the patient’s vessels is seen in angiography, the vessel wall of the patient can also be seen in coronary CT angiography. Thus, the structure of the plaques in the vessels can be analyzed. Plaque content analysis is important because the prevalence and character of plaque also provides information on whether the patient falls into the high-risk group. The treatment of the patient is planned according to all these evaluations. Although patients are sometimes at high risk, the effort test may be normal. For this reason, if the patient is seen in the risk group by the physician, Coronary CT angiography is recommended and sometimes critical stenosis may occur in this examination. Drug treatment is started or current drug treatment is arranged in patients with moderate or mild plaques, where stenosis does not indicate a critical condition. In addition to these, Coronary CT angiography is also performed in patients with existing heart disease to see the course of the disease and whether there are additional problems. Coronary CT angiography is not recommended in patients with very small diameter stents. If the stent sizes are appropriate, the presence of stent narrowing can also be checked with Coronary CT angiography.
Coronary CT angiography is sometimes used to measure the amount of calcium in completely occluded vessels, to plan the passage of wires to be used during the procedure, and to determine the treatment strategy. Coronary CT angiography is also important for guiding difficult procedures. In addition, although it only takes 5-6 minutes, it takes as little as 40 minutes in total with the steps such as informing the patient, opening the vascular access, giving the necessary drugs and performing the procedure.
The advantages of coronary CT angiography are listed as follows:
Image quality is very high.
It is frequently preferred in coronary artery disease because it gives high resolution images. It also provides advanced information on anatomy and vascular connections in complicated and simple congenital heart diseases.
Since it takes a short time like 5-7 minutes for shooting and there is no noise problem as in MR, it does not cause discomfort to the patients.
There is no pain during and after the procedure.
It can be safely applied in patients who have undergone stenting or bypass surgery, or in patients who are not known to have coronary artery disease before. Detailed information about coronary anatomy and stenosis levels can be obtained.
What is the process of cardiac tomography/coronary CT angiography?
After the patient is informed about the procedure, he is asked to fill out a consent form. Then, if the patient does not have a recent creatinine measurement, blood is taken from the patient on the day of the procedure and the creatinine value is checked. The creatinine value is important as a contrast agent will be given during the procedure.
The patient’s vascular access is opened and he is placed on the stretcher inside the tomography device. If necessary, drugs are given to adjust the heart rate through the vascular access. Breath commands are explained to the patient. Because if the patient does not breathe properly and the image cannot be stabilized, situations that reduce the quality of the shot called ‘artifact’ may occur. In such a case, the procedure will not be valid, because the coronary artery structures are very thin structures and a disorder in the image may mislead the doctor. For this reason, breathing commands are practiced beforehand, and how much the heart rate drops with breath holding is checked. However, depending on the contrast agent given, the patient’s body may feel warm, urinary incontinence, and a metallic taste in his mouth. The patient is also informed about these in advance so that he does not panic during the procedure and his heart rate does not increase. If the patient knows these in advance, there is usually no problem. Since the cardiac tomography process is very short, it is not a problem even for patients with claustrophobia.
Another important issue in tomography is the patient’s heart rate. It is desired that the heart rate be around 60 thanks to the drugs he was using before the procedure or the drugs given intravenously that day. Otherwise, you may encounter situations that deteriorate the image quality, called artifacts.
In addition to all these, the medications taken by the patient beforehand should be questioned in detail. Especially before the procedure, it should be known whether he uses some drugs that increase sexual power. If the patient has a recent history of using this group of drugs, it is decided by their doctor whether the procedure will be performed or not. Because, in case of simultaneous use of these drugs and the sublingual spray to be given to the patient during the procedure, blood pressure can drop seriously. This can be life-threatening. For this reason, it is very important for patients who use sexual power-enhancing drugs to inform beforehand.
Frequently asked questions about cardiac tomography
What are the disadvantages of cardiac tomography/coronary CT angiography?
There are two important points to note regarding this issue. Cardiac tomography contains radiation and contrast media can be dangerous in patients with kidney failure. In our center, techniques are applied to ensure that the minimum level of radiation is received according to the body surface area, body structure and the degree of calcification in the veins of our patients. The amount of contrast material is also kept at a minimum, taking into account the characteristics of the patient.
Which patients should not undergo cardiac tomography/coronary CT angiography?
Since contrast material is used in the procedure, the procedure should be decided by the patient’s physician and nephrology in patients with chronic kidney failure. Coronary CT angiography will not yield optimal results in patients with small diameter stents. For cancer patients who are preferred not to receive radiation, if a tomography is required, the shooting is performed by being cautious about taking the minimum radiation dose. Apart from this, the procedure can be applied to all patients.
What should be considered after cardiac tomography/coronary CT angiography?
In a patient with kidney problems, it may be necessary to give fluids for a while before and after the procedure. Patients whose heart failure is not detected after the procedure are asked to drink 2-2.5 liters of water. This application allows the contrast agent to be easily removed from the body. After the procedure, patients should not stand up suddenly. First, they are allowed to sit for a while, and the pulse and blood pressure are checked. In cases such as dizziness and low blood pressure, the patient is kept under follow-up for necessary intervention. Then the reporting process can take 1-2 days.
Is it possible to stay near pregnant or small children after cardiac tomography?
Since the heart tomography does not contain a radioactive substance as in the procedures performed in Nuclear Medicine, there is no need to pay attention to anything after the procedure.
Is there any pain in the heart tomography procedure?
No, no pain is felt.
Is there a risk of allergy in cardiac tomography?
Since allergy may develop due to the contrast agent given in the procedure, a detailed allergy history is taken from the patient before the application. In case of allergy, the procedure is performed after the protective drugs are given and the patient is kept under observation for a longer period after the procedure. In patients with a history of serious allergies such as anaphylaxis, the Allergy Department is consulted and precautionary measures are discussed.