What is a CT coronary angiogram?
CT (computerized tomography) coronary angiogram is a non-invasive test that is used to assess the anatomy of the coronary arteries that supply heart muscle and determine whether they are narrowed or blocked. The coronary arteries supply blood to heart muscle.
The test is performed by injecting contrast dye into a vein and then using a CT machine to scan the heart. It is a non-invasive test compared to a heart catheterization, where a cardiologist inserts a catheter into an artery and threads it to the heart to inject dye into the arteries and take images.
The CT coronary angiogram can see whether coronary arteries are narrowed, and determine how narrow or even whether they are completely blocked. The test can also look for structural abnormalities of the heart, aortic aneurysms, and potentially pulmonary embolism (blood clots in the lung).
The CT coronary angiogram is a diagnostic test only, while a heart catheterization can also allow the cardiologist to treat heart blockages, if they are found, with an angioplasty or stent.
CT coronary angiogram vs. CT coronary calcium score
A CT coronary angiogram is different than a CT coronary calcium score, where dye is not injected, and whose purpose is to assess how much calcium and plaque are located within the coronary arteries. The CT coronary calcium score is a screening test only and does not assess blood flow in the arteries.
Why does a doctor order a CT coronary angiogram?
Heart muscle is like any other muscle in the body requiring a constant supply of oxygen rich blood supplied by the coronary arteries, that lay on the surface of the heart. Should those arteries narrow (coronary artery disease) and not supply enough oxygen, the heart muscle may ache, similar to legs that get sore after running or backs that get tired after lifting weights.
Pain associated with coronary artery disease is called angina, but all patients do not experience or describe similar pain. Some patients may have chest pressure or tightness that radiates to the shoulder, arm or jaw, some may have shortness of breath or nausea, while others may just have fatigue or indigestion.
A CT coronary angiogram is one of the tests that is able to help assess whether chest pain or other associated symptoms are being caused by coronary artery disease and narrowed or blocked coronary arteries.
What is the procedure for a CT coronary angiogram?
This CT uses the power of computers to take images of the arteries of the heart at the exact time when injected intravenous dye arrives.
Steps of a CT coronary angiogram:
- The patient changes into a gown and is placed on the CT table
- An IV line is inserted into a vein in the arm
- A heart monitor is placed to observe the heart rate and rhythm
- The table slides into the machine
- Contrast material is injected into the IV
- The patient is asked to take a deep breath and hold it for 5-10 seconds while the scan takes place
- The test is now complete
Patients may need to take medicine prior to the test to slow the heart and allow the best images possible. Beta blocker medication, like metoprolol, may be taken hours prior to the test.
Often the patient is asked to fast and not eat for a few hours prior to the CT. As well, caffeine should be avoided for 8-12 hours prior to the test.
Are you sedated for a CT coronary angiogram?
There is no need for sedation. The patient needs only to hold still for a few seconds. Most patients tolerate the procedure well.
How long does a CT coronary angiogram take (duration)?
While it may take time to get changed into a patient gown, have monitors placed and the IV started, the test itself only takes seconds.
QUESTION
In the U.S., 1 in every 4 deaths is caused by heart disease. See AnswerWhat is the recovery from a CT coronary angiogram?
The CT is non-invasive other than the IV line being placed. There is no recovery or rest time and the patient can leave immediately if they choose.
Can you drive home after a CT coronary angiogram?
There are no restrictions on driving after the test is complete.
What does a CT coronary angiogram show?
The CT coronary angiogram will show the anatomy of the coronary arteries that supply blood to the heart muscle. The test may determine whether a narrowing (blockage) exists, and how severe that blockage might be.
The test may also estimate ejection fraction, the percentage of blood in the left ventricle being pumped to the body. A normal ejection fraction is 55-75%. A decreased percentage might be due to heart muscle that is previously damaged, or due to a cardiomyopathy, where the heart muscle does not contract normally.
The CT coronary angiogram may also look for aneurysms or other structural problems of the heart.
What do the results of a CT coronary angiogram mean?
The purpose of the CT coronary angiogram is to help determine whether the patient’s complaints, whether it is chest pain, shortness of breath, indigestion, fatigue, or other symptoms can be explained by narrowing of the coronary arteries.
Mild blockage of an artery may or may not be enough to cause symptoms. The test results will need to be interpreted by the primary care provider or cardiologist who is caring for the patient and the results correlated to symptoms, risk factors, and other test results.
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DISCHARGE Trial Group. Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial. BMJ. 2022.
Linde JJ, Kelbæk H, et al. Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol. 2020. 75(5):453-463
Gray AJ, Roobottom C, et al. RAPID-CTCA Investigators. Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial. BMJ. 2021.
Rybicki FJ, Udelson J, et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol. 2016. 67(7):853-79
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