What is a CT scan (calcium score) screening and how is it important for early detection of coronary heart disease? Who is at risk and should take the test? We interview Dr Chrystal Fong, family physician at Asia HealthPartners, on these important questions and more.
1) What Is Coronary Heart Disease And How Common Is It In Singapore?
Coronary artery disease (CAD), also known as ischaemic heart disease (IHD), occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow due to build-up of fatty deposits called plaque on their inner walls. The hardening of the artery walls is known as arteriosclerosis, while the build-up of plaque is known as atherosclerosis.
According to the health statistics from the Ministry of Health (MOH) registry, IHD is the 3rd leading cause of death in Singapore, accounting for 19.7% of all deaths.
On average, 34 people have heart attacks and 23 people die from heart disease daily, and the numbers are projected to rise with a rapidly ageing population.
It is estimated that one in three Singaporeans may have underlying early heart disease that remains undetected.
2) Who In Particular Is At Risk Of Coronary Heart Disease And What Are The Symptoms To Watch Out For?
Coronary Heart Disease Risk Factors
The risk factors for coronary heart disease can be classified into non-modifiable and modifiable risk factors.
The non-modifiable risk factors include:
- Age – A person’s risk of developing cardiovascular disease increases with age.
- Gender – Men generally face a much higher risk of heart disease than women. They also tend to suffer heart attacks earlier in life. Three categories of women – namely, menopausal women, women taking oral contraceptives, and pregnant women – are particularly vulnerable to cardiovascular disease.
- Family history – A family history of stroke or heart disease, especially if it occurred at an early age for the affected family member, is a strong risk factor for cardiovascular illnesses.
The modifiable risk factors include:
- Hyperlipidemia (‘high cholesterol’)
- Hypertension – Defined as greater or equal to 140/90mmHg measured on two or more occasions
- Diabetes
- Overweight/obesity – Singaporeans are at a greater risk of developing heart disease and diabetes when their BMI values are greater than 23 kg/m2.
- Smoking
- Physical Inactivity
- Unhealthy diet
- Stress
Coronary Artery Disease Symptoms
Depending on the severity of heart disease, you may or may not experience symptoms.
If you do experience symptoms, they may include:
- Shortness of breath or breathlessness on exertion or when lying down
- Decreased effort tolerance
- Pain in the neck, jaw, throat, upper abdomen or back
- Chest pain (angina) on exertion with or without radiation to the left arm
- Severe chest discomfort lasting more than 10 to 20 minutes
3) What Is A CT Scan (Calcium Score) And How Important Is It As A Screening For Coronary Heart Disease?
A coronary calcium scan, sometimes referred to as “CT scan (calcium score)” in health screening packages, is a low dose CT scan of the heart. It is used to produce images to measure how much calcium-containing plaque is in a person’s arteries. This assists in assessing a person’s risk of developing coronary heart disease.
Who Needs To Undergo A CT Scan (Calcium Score)?
People who should have this test include those with the following risk factors:
- family history of heart disease
- obesity
- high cholesterol
- high blood pressure
- smoking
- high levels of stress
4) What Can A Person Expect When Undergoing A CT Scan (Calcium Score)? Is There A Danger Of Radiation Exposure?
There is no special preparation for the scan. The CT exam is painless, fast and easy, and there is no requirement for injection of contrast.
During The Procedure
- Electrodes will be placed on your chest to monitor your ECG (electrocardiograph)
- The scan is done using a computerized tomography (CT) scanner.
- You will lie on your back on a movable table. The table slides into a large machine shaped like a tube. Your head is outside the scanner the whole time.
- You may be given medicine to slow your heartbeat. This helps create clearer images. If you are nervous or anxious, you may get medicine to relax you.
- You need to stay still while the pictures are taken. You may be asked to hold your breath for a few seconds. The health care professional doing the test can see and talk to you the entire time. The test takes about 10 to 15 minutes.
After The Procedure
- You usually can drive yourself home and continue your daily activities after the test unless your doctor tells you not to do so.
- The scan exposes you to low dose radiation, equivalent to the same amount of radiation exposure as a mammogram.
- No radiation remains in a patient’s body after a CT exam.
5) What Other Tests Should Patients Go Through Annually If They Are Concerned About Heart Disease?
An annual health screening is recommended.
The other tests recommended for annual screening of heart disease may include:
- Blood tests
Blood cholesterol, fasting glucose, Hba1c, lipoprotein a, lipoprotein b , full blood count , homocysteine, CK (creatinine kinase), liver function test, kidney function test, thyroid function test, hsCRP , urine albumin/creatinine ratio, vitamin D
- ECG
- Chest X-ray
- Exercise stress test
- Echocardiogram
- Nuclear stress test (also known as cardiac PET scan)
- Angiogram
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This article is informative only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.
