Frequently
asked
questions.

Here we explain the answers to the most common queries that we receive from patients.

What about COVID19?

Our host site the Surrey Cardiovascular Clinic remained open throughout the pandemic. By adopting appropriate safety measures we had zero COVID 19 cases enabling us to launch our new CT services as COVID 19 safe.

Our staff are all swab tested each week and all patients undergo careful screening pre arrival and then on arrival. We have in-car waiting (so no waiting area contamination).

During COVID 19 there has been a major increase in cardiovascular mortality and morbidity as a result of poor access to specialist services so we have taken the view that we will take precautions and stay open as usual, following government guidelines.

What is VCL’s HeartScan?

VCL HeartScan, also known as a Coronary Artery Calcium (CAC) scan, is a targeted heart CT scan which assesses whether there is calcium within the walls of the arteries that supply blood to the heart muscle (coronary arteries )combined with a 12 lead ECG, blood cholesterol and blood pressure assessment. Dangerous coronary artery narrowing’s are caused by the deposition of cholesterol into the walls of arteries. After the cholesterol has been laid down it gradually hardens with calcium. The calcium is easily visible with a CT scan and the CT scan allows for the accurate measurement of how much calcium is present in the arteries. There is extensive scientific evidence that the amount of calcium present is related to an individual’s risk of having a heart attack or dying of heart disease and that given the appropriate targeted medical treatment these risks can be dramatically reduced.

What is a CAC scan useful for?

CAC scanning is useful to detect the presence of coronary disease and assessing one’s personal future risk of having a heart attack. This can help guide lifestyle decisions and therapeutic interventions for the prevention of coronary artery disease. It can be particularly helpful test when making a decision whether to start a statin (cholesterol lowering drug) in a patient with an intermediate risk of developing coronary artery disease.

Who should consider having a CAC scan?

Our VCL Medical members would consider individuals with a medium risk for heart disease as those that are likely to gain most. This is usually present in in people over 40 years old with an additional risk factor for heart disease such as high blood pressure, smoking, diabetes, an abnormal cholesterol, or a family history of heart disease in a close relative at a young age.

CAC scoring can be extremely helpful in deciding an individual’s need to going on statin (cholesterol lowering) medication.

Who should NOT have a CAC scan?

If you are under the age of 40 it is unlikely that you have calcification in the coronary arteries and in most cases CAC scoring is unhelpful for assessment of cardiac risk. Patients who have known coronary artery disease such as those who have previously had a heart attack, coronary stenting or a bypass do not benefit from calcium scoring. Patients with known very high risk of coronary artery disease are also likely to benefit less from the test.

What is the price for a calcium artery calcification (CAC) scan?

Our market research and experience shows the price currently varies from £400-500 for this scan, however, by including in our VCL HeartScan; a CAC score AND a 12 lead ECG (list price £90); blood cholesterol (costing £25) and BP assessment, we believe our CAC scan represents unparalleled value for money. Our objective is to make the VCL heart scan lower cost by increasing volumes and improving workflow.

What is the difference between a CAC scan (HeartScan CAC) and a CT Coronary Angiogram (HeartScan CTCA)?

A CAC scan (HeartScan CAC) uses no contrast. It will not detect non-calcified (so called ‘soft’) plaque disease within the coronary tree. In contrast a CT Coronary angiogram (HeartScan CTCA) involves passing iodine based x-ray contrast into the heart via a vein to image the lumen or ‘pipework’ of the heart.

Cardiologists use a combination of CAC scan and CTCA to investigate their patients who present with symptoms of a possible heart disease.

What is the difference between a CT Coronary Angiogram (HeartScan CTCA) and an invasive coronary angiogram?

An invasive coronary angiogram is the gold standard investigation for coronary heart disease required before a stent or bypass operation can be carried out.

A CT coronary angiogram is a non-invasive test that uses a CT scanner to obtain similar information without intrusion and is thus safer and more convenient test to find out whether a patient might benefit from invasive angiogram and or treatments such as stents of bypass surgery.

When is an invasive angiogram required versus a non-invasive CT Angiogram and how is an invasive coronary angiogram undertaken?

An invasive coronary angiogram is the gold standard investigation for coronary heart disease required before a stent or bypass operation can be carried out.

A CT coronary angiogram is a non-invasive test that uses a CT scanner to obtain similar information without intrusion and is thus a safer and more convenient test to find out whether a patient might benefit from an invasive angiogram and/or treatments such as stents of bypass surgery.

How is a CT Coronary angiogram (HeartScan+) done and is it safe?

CT coronary angiography is extremely safe, does not require admission and can be a walk-in and walk-out test. Its main risks are iodine allergic reactions (rare) and of course the very small risks of radiation involved.

We are often required to lower the heart rate using betablocker medication prior to the scan to allow accurate imaging of moving targets (the coronary arteries move with each heart beat) at the lowest possible dose of x-ray. Prior to the test a small tube is placed into a vein through which an injection of x-ray contrast is pumped that circulates via the vein into the right heart, pulmonary artery and back into the left ventricle where it is passes into the aorta and coronary arteries. At the precise moment this x-ray dye appears in the coronary arteries, the CT scanner is activated to acquire multiple slices of the chest. These images can then be manipulated in a computer workstation in order to create a 3D virtual angiogram images of the coronary tree showing any coronary heart disease in the walls or lumen of the coronary arteries.

Does a calcium score scan involve radiation?

Yes. The average calcium score provides about 1 millisieverts (mSv) of radiation to image the calcium in the heart arteries, this is similar to the radiation from a mammogram. The average person receives about 3 mSv in background radiation from natural sources each year. Exposure to radiation can increase one’s lifetime risk of cancer and if patients have had many x ray or CT examinations previously they might want to seek advice from their doctor prior to undergoing a CAC scan.

Can I refer myself for a CAC Scan?

No. Heartscan direct will only undertake CAC scans on individuals referred by a suitably trained healthcare professional who can balance the risks versus the benefit. This is usually people who over the age of 40 without known heart disease, but with risk factors that may predispose them to heart disease.

Heartscan Direct will give you a report of your scan and this will explain the results, they will also with your consent, send a copy of the report to your GP.

I had CAC score years ago, is it worth having another one?

Generally speaking repeat CAC scoring is unhelpful, particularly in individuals who have previously had an elevated CAC score. This is because the previous elevated CAC score should have resulted in the necessary treatments being initiated to prevent progression of coronary artery atherosclerosis. In people who have previously had a low CAC score but have risk factors for heart disease and are not on treatment such as statins, repeat CAC scoring after >5 years can help further risk stratify individuals, as long as the outcome of the test is likely to alter patient management. Individuals should not have a repeat CAC score within 5 years.

My GP has calculated my cardiac risk to be low, is it worth being referred for a CAC scan?

UK GPs and doctors all over the world use risk-calculators such as Q-scores that are based on Framingham population studies. These provide a relatively rough idea of your future cardiovascular risk, however since approximately 50% of coronary disease risk cannot be explained using traditional risk factors these are not as accurate at predicting future risk as a personalised CAC score, which is proven to be a more accurate predictor of your risk.

There is clear scientific evidence that people with a low Q risk (and thus not offered prevention measures including statins) can have raised CAC score where prevention measures are advisable, conversely many people with a raised Q score have zero coronary calcification, where the use of statins would appear to be less impressive.

I have regular Stress ECG tests for work, is there any point being referred?

Yes. Stress ECGs only detect severe narrowings (>70%) in the major blood vessels of the heart by inducing changes to the ECG under stress, triggered by lack of blood flow to the heart muscle. CAC scoring is much more sensitive because it picks up calcium deposition in the artery walls which can occur many years before coronary narrowings or heart attacks occur. CAC scoring allows for much earlier preventative action being taken which can dramatically reduce one’s risk of having a heart attack or developing a critical coronary narrowing later in life.

I feel fit and can exercise to a high degree without symptoms such as chest tightness or feeling short of breath, is there any point having a CAC Scan?

Yes, there may be. If you are over 40 and have risk factors for heart disease, such as a history of elevated cholesterol, high blood pressure, diabetes, smoking, or a family history of heart disease, then CAC scoring is extremely effective at picking up early changes in the heart arteries which may not cause symptoms until years later. This allows for the early treatment and can significantly reduce one’s future risk of a heart attack or angina.

As a medical practitioner, how do I refer my patient for a CAC Scan?

You can refer via our website www.heartscandirect.com, you can call our office on 01483 467100 or download scan request forms www.scvc.co.uk/forms. GP direct access CAC referrals are permitted by GPs that have applied to become partner members and completed our training programme.

Are there any contraindications to having a CAC scan?

Yes, CAC scanning in pregnancy is contraindicated. If you are under 40 years old then CAC scanning is often unhelpful and unless there were very specific concerns regarding one’s risk, we would not undertake the scan. In patients with established coronary artery disease such as those who have had a heart attack, stenting or bypass surgery then CAC scanning does usually not offer any additional information.

Where will my CAC scan be undertaken?

Our scans are acquired using a very fast CT scanner (160 slice) that our host companies such as Surrey Cardiovascular Clinic Ltd operates with us at 5 Huxley Road Guildford.

Depending on demand and patient convenience, in the future we may also be offering our scans at other locations across Surrey.

What is the difference between a CAC scan and an Echocardiogram heart scan?

An Echocardiogram is an ultrasound test used to look at the heart structures including valve function. Unfortunately ultrasound does not have the ability to detect coronary artery disease or the microscopic deposits of calcium found in and around coronary vessels many years before symptoms develop. A CAC scan uses very fast x-ray to do this and conversely does not provide any information about the function of the heart and its valves. Cardiologists use both techniques in order to diagnose heart conditions in their patients.

My dad had a heart attack when he was 50 years old, should I have a CAC Scan?

If you have a first degree relative (parent or child) affected by a ‘heart attack’ that was due to a blocked coronary artery (Myocardial infarction or ‘coronary thrombosis’ ) then you are likely to be at increased risk of having the same condition and should consider taking steps to reduce your risk.

If you have multiple other risk factors such as smoking, raised blood pressure or diabetes (all of which will increase your calculated Q Risk), it is possible that your risk of developing heart disease means that your GP will advise a prevention programme, including statin therapy, in which case having a CAC scan may not greatly alter management.

In contrast if you have no other obvious risk factors, your Q Risk will be low, perhaps providing false reassurance that all is well. The CAC scan in such intermediate risk cases is a very important way of finding out where you stand, and what, if anything, you need to do to stay healthy.

Is there any clinical urgency to have a CAC Scan?

As long as you are not experiencing chest symptoms or angina, the timing of a CAC scan is not important as coronary heart disease takes many years to develop.

How long will I have to wait for a calcium score scan?

Heartscandirect’s high volume CAC scan service starts in November 2020, after which time we aim to have only short waiting times.

I have been getting chest pains when walking, should I have a CAC Scan?

Anyone experiencing possible cardiac symptoms such as chest symptoms on effort may have critical coronary artery or valve narrowing that threatens life. They should see their GP or attend Hospital to see a Cardiologist without delay. Once clinically assessed and triaged the Cardiologist may recommend a CAC scan as part of the investigation, however more often will recommend a full CT or invasive Coronary angiogram instead.

I feel breathless whenever I do any physical activity, should I have a CAC Scan?

Breathlessness is very common and can be a presenting symptom of many conditions, including heart disease. Although many patients we see with severe heart disease present with breathlessness instead of chest pain or angina there are multiple other causes that would NOT be detected by having a CAC scan.

If you are over 40 and have unusual or unexplained exertional symptoms you should therefore see your GP or one of our specialist consultants.

Does a CAC Scan predict all future heart events?

No single test can predict all future heart problems since there are many heart conditions that can be dangerous. Coronary heart disease is however one of the most common conditions affecting man and certainly one of the leading causes of preventable sudden death and shortened life span in the world.

If you have concerns about other heart conditions such as Cardiomyopathy or arrhythmia's, then you should consider having a broader health screen (such as SCVCs Platinum heartscreen), which includes a 12 Lead ECG, Echocardiogram, Exercise stress ECG, blood tests, health questionnaire and CAC score along with Cardiologist report.

I take medication, will this affect me having a CAC Scan?

No, the scan can happen irrespective of medication.

I have atrial fibrillation, will this affect me having a CAC Scan?

No, the scan can work fine in atrial fibrillation although its best that your heart rate at rest does not exceed 100 beats per minute.

I am diabetic I take medication, will this affect me having a CAC Scan?

If you are diabetic then you are already at increased risk of having the same condition and should consider taking steps to reduce your risk.

If you have multiple other risk factors such as smoking, raised blood pressure (all of which create a raised Q-Risk) or family history it is possible you already have such a high risk of developing heart disease that you and your GP have started a prevention programme, in which case having a CAC scan may not alter management. In contrast if you have no other obvious risk factors your Q-Risk will be low perhaps providing false reassurance that all is well. The CAC scan in such intermediate risk cases is very important way of finding out where you stand, and what if anything you need to do to stay healthy.

I have a coronary stent, can I have a CAC Scan?

Any person that has had a heart attack, angina, bypass surgery or coronary stent is already at high enough risk to have full prevention measures in place. Even the small radiation dose used in a CAC scan cannot be justified as a medical exposure to radiation and you should therefore NOT undertake a CAC scan. At our host organisation Surrey Cardiovascular Clinic, like many cardiology clinics, we operate stress ECG and Stress Echo testing which can be used instead to monitor patients with such prior heart conditions.

I am 80 years old and feel well, is there any point having a CAC Scan?

The predictive power of CAC scans is not age dependent once over 40 years of age. If you are elderly, with life expectancy being very good, the CAC scan is highly predictive or being affected in next 10 years and might detect coronary disease that will cause a preventable heart attack.

Due to increased risk of heart disease with age, older patients with major coronary calcification and high CAC are at much higher risk of suffering a heart attack so may wish to know where they stand and take prevention measures if their CAC scan shows problems.

I am 20 years old and have heart disease running in the family, should I have a CAC Scan?

Coronary calcification is rare below 40 years of age. The scan cannot be justified in younger patients. Younger people with strong family history should however take steps to protect themselves by not smoking, being physically active, healthy diet and see their GP for a Cholesterol test since if blood cholesterol is high, they would qualify for statin therapy even at 20 years of age.

I have had a coronary artery bypass surgery (CABG) in the past, should I have a CAC Scan?

Any person that has had a heart attack, angina, bypass surgery or coronary stent is already at high enough risk to have full prevention measures in place. Even the small radiation dose used in a CAC scan cannot be justified as a medical exposure to radiation and you should therefore NOT undertake a CAC scan. At our host organisation Surrey Cardiovascular Clinic, like many cardiology clinics, we do operate stress ECG and Stress Echo testing to monitor patients with such prior heart conditions.

I have had a heart attack in the past, should I have a CAC Scan?

Any person that has had a heart attack, angina, bypass surgery or coronary stent is already at high enough risk to have full prevention measures in place. Even the small radiation dose used in a CAC scan cannot be justified as a medical exposure to radiation and you should therefore NOT undertake a CAC scan. At our host organisation Surrey Cardiovascular Clinic , like many cardiology clinics, we operate stress ECG and Stress Echo testing to monitor patients with such prior heart conditions.

I am, or used to be a heavy smoker, would a CAC Scan look at my lungs too for early lung cancer?

Only a small part of the whole lung is looked by the CAC scan. If you have a long history of smoking there is evidence that a whole chest lung scan can detect early lung cancers and you should discuss this with your GP.

Occasionally we do pick up lung abnormalities during a CAC scan that will lead to recommendation for further scans, which thankfully in over 97% of cases turn out to be benign.

Who will do my scan and where?

VCLs Heartscandirect.com works in partnership with specialist health clinics such as Surrey Cardiovascular Clinic in Guildford and Mount Alvernia BMI hospital who host CT services where specialist CT radiographers undertake the state-of-the-art scans on our patients using modern multislice CT scanners, before sending the imaging data back to us for immediate processing and reporting by our expert teams.

This arrangement allows us to manage demand and provide high level quality control, unlocking the huge potential for cardiac CTs to become more accessible to people.

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How to book

Not sure? Call 01483 467 100 or see our FAQs for more information