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    high calcium score, normal stress test
    An_257901 posted:
    Hi, I'm new to this and writing about my mother who recently received a super high calcium score after a heart scan (816 total) and who has a family history of heart disease. She has passed stress tests and her cardiologist just ordered a new treadmill stress test, which she passed as well. I'm so worried because I know that high calcium scores correlate strongly with cardiac events but her doctor doesn't seem to want to do anything since she passed a stress test. He MAY put her on a statin. It's a very gray area. I know angiograms are invasive but both she and I might be able to get some sleep if we knew exactly what her blockages looked like and how much soft plaque was in her arteries. Should I seek out a second opinion? I don't know if any cardiologist will perform an angiogram without a failed stress test. But look what happened to Tim Russert (death from heart attack) and Bill Clinton (bypass surgery) after their normal stress tests. Can't sleep and extremely worried. Please advise if any have been through similar situations. Thanks!
    billh99 responded:
    Typically a blockage does not affect performance that would show on a stress test until it reaches 70-80%.

    However, typically it is unstable plaque in the range of 20-40% that can rupture. When that happens the body treats it as a wound and forms a clot. And thus cause a heart attack.

    But an angiogram won't show those small blockages.

    He MAY put her on a statin

    With the family history and her high score I am surprised that he has not already done that. One of the "side effects" of statins is to help stabilize plaque.

    She might want to look for a cardiologist that specialized in prevention.

    Also there is a test called CT angiogram. In that a contrast material is injected and then a CT is run. It suppository has a good record of showing blockages.
    cardiostarusa1 responded:

    ......"a super high calcium score after a heart scan (816 total)

    Coronary artery calcium CT scan

    The extent of CAD is graded according to your calcium score.

    Calcium Score

    0 No evidence of CAD

    1 - 10 Minimal evdence of CAD

    11 - 100 Mild evidence of CAD

    101 - 400 Moderate evidence of CAD

    Over 400 Extensive evidence of CAD

    "She has passed stress tests and her cardiologist just ordered a new treadmill stress test, which she passed"

    Stress tests are not 100% perfect, and from time-to-time, can yield a false-negative or false-positive result.

    One example, and at the very extreme, a nuclear stress test can appear normal in some individuals with multi-vessel coronary artery disease (CAD), said to occur due to so-called "balanced ischemia"

    "He MAY put her on a statin. It's a very gray area."

    While on the subject of statins, noteworthy, there are advanced blood tests, such as NMR and VAP, that show the SIZE of one's cholesterol particles, providing detailed info that can help to determine if one should really be on a statin.

    Additionally, statins are good for some individuals, bad (side effects/adverse reactions, such as memory loss, muscle aches/pains) for others. On an individualized case-by-case basis, the benefits of taking a statin, at any dose, must clearly outweigh the risks.

    On the positive side, statins may/can stabilize vulnerable plaque (VP).

    VP hides well-away within the vessel wall (essentially a 0% blockage, but still unequivocal atherosclerosis), can't be seen with invasive X-ray angiography/angiogram, causes no advance warning signs/symptoms, and is now recognized worldwide as the cause of the majority of heart attacks by way of plaque rupture causing a blood clot (thrombus).

    Statins also have anti-inflammatory properties and as applicable to the patient, thus lowers C-reactive protein (CRP/hs-CRP). Inflammation is recognized as a major player in the development and progression of atherosclerosis.

    Most of the plaques involved in coronary artery disease (CAD) are not the plaques that significantly narrow the artery.


    "Only one in seven heart attacks is caused by a blockage of more than 70 percent. It's the classic tip of the iceberg problem. We've become facile at treating the tip of the iceberg, BUT the most dangerous part is still below the surface."

    - Steven E. Nissen, M.D., vice-chairman of Cardiology, head of Clinical Cardiology, Cleveland Clinic

    "The angiogram is just shadows, it doesn't tell us what's going on in the vessel wall, where all the action is at."

    - Eric J. Topol, M.D (formerly of the Cleveland Clinic)., cardiologist, professor of medicine, Department of Molecular and Experimental Medicine, chief academic officer of Scripps Health and director of the Scripps Translational Science Institute

    "I know angiograms are invasive but......

    Beyond the the invasive angiogram/heart catheterization, which carries risks and the possibility of complications, some unforeseen), as applicable for the patient, there is also the non-invasive 64-slice Cardiac CT, which does not rquire stressing the heart, and allows doctors to view/examine the heart and the coronary arteries in never-before-seen detail.

    Far better yet, the newer blazingly fast (benefit of less radiation exposure to the patient, and less contrast media) 320-slice Cardiac CT scanner can measure subtle changes in blood flow, or minute blockages forming in blood vessels, no bigger than the average width of a toothpick (1.5 mm) in the heart, and the brain

    Best of luck to your mother down the road of life.

    Take care,


    WebMD member (since 8/99)




    "Be a questioning patient. TALK to your DOCTOR and ASK QUESTIONS. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"

    - Charles Inlander, People's Medical Society
    advocateforhealth replied to billh99's response:
    Thanks for the information. I appreciate your time.
    advocateforhealth replied to cardiostarusa1's response:
    Very thorough and informative. Thank you.
    cardiostarusa1 replied to advocateforhealth's response:
    You're welcome.

    Take good care,



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