OK, to start with you are not my doctor and I am not seeking specific medical advice. I have a doctor and he is out on vacation until next week, so I’d like to understand my condition more before we discuss.
So as part of my retirement I have been taking medical test to ensure that I am OK to move to the Philippines in May. Had my colonoscopy, A1AC, cholesterol, dental and physical checkups, all of which well. Then my doctor suggested that since I am over 60, I should have CT scan for calcium buildup around my heart, it came back at 738 which is supposedly worst than 80% than all men in my age group (I’m 63). Naturally I am very concerned, as having a heart attack 10,000 miles away from home is serious as a heart attack gets. Should I be overly concerned about this? What should be my next steps other than talking with my doctor?
Some things I found out is that the CT scan is not the end all of test that determine if you are at risk having heart problems, but it is an initial indicator that there is an issue. I did have some chest pain around my heart area a few weeks prior to my doctor recommending the test, he thought it may have been due to stress since it only lasted less than a minute and that I was in pretty good shape for a man my age.
Which should be the next step in testing? A stress test where they put you on a treadmill and see if I keel over? An angiogram test to look at my heart vessels? Is that too risky? Would angioplasty or stents be in my future? Open heart bypass surgery?
From my understanding is that even though I appear and test healthy in all other aspects I could just keel over and die from this at any time. Just last November I was in the Philippines walking almost 10 miles a day during high heat and humidity and was loving it, no indication of a problem with my ticker. Am I overreacting? Or is this the nature of the beast?
So, I am asking to delay my retirement date until August so that I can use my company insurance to cover the expenses related to figuring out what to do next. Not happy about that, but I’m more sure that I would not be happy to have issues while I am in a third world country.
To aid others in addressing Si_Amigo’s question, I’m posting the Mayo Clinic article about the medical test he underwent:
A coronary calcium scan is a special computerized tomography (CT) scan of the heart. It looks for calcium deposits in the heart arteries. A buildup of calcium can narrow the arteries and reduce blood flow to the heart. A coronary calcium scan may show coronary artery disease before you have symptoms.
When I first read the OP, I imagined actual deposits of “stoney” calcium covering the heart muscle like strips of wet papier-mache covering a balloon. I was thinking of direct constriction of the heart muscles’ contractions. But the linked article makes clear what was actually being tested and what Si_Amigo’s doctor actually found.
You’ve named some of the possible testing. IMHO (IANAD), it’s too soon to be thinking about treatment possibilities. That’s putting the cart before the horse.
You probably need blood work, a detailed history and family history, stress testing, probably an echocardiogram and/or more sensitive imaging, some of which you named.
But what you really need is a good cardiologist to look at the whole picture and guide the next steps.
As a guy born at Beaumont Hospital, your ‘title’ tells me you’re a Detroiter. Although Detroit and environs has some good facilities, would you consider getting referred to …
?
Good luck. Don’t panic. Your number is high, but it’s too soon – and counterproductive – to worry too awfully much at this point.
I was over 500 at age 57, so I underwent a battery of other tests (echocardiogram, stress test, ultrasounds of my carotid arteries) and started taking statins.
Yes, I am in Oakland County and Henry Ford Ascension is my network, I’m fairly close to Ann Arbor so I’ll investigate University of Michigan if it gets to that point, thanks!
As for worrying, not so much but I want to be pragmatic. I was planning on leaving Michigan for the Philippines in May and I would be without a comparative health care plan (or family support) while I was there. I am dialing back my decision to go in May because I don’t feel that there is not enough time to properly have the doctors assess my condition, and I don’t want to rush into this possible life or death decision. Since I have the option to extend out my retirement I will do so.
Also, I don’t think it’s a wise decision to go to a tropical rain forest zone in the middle of the summer monsoon season with a possible heart condition. Just doesn’t feel right.
Just today I had a nuclear stress test, where their device takes dozens of pictures of your heart and area arteries from different angles, then hit the treadmill and get injected with marker solution, then get scanned again. I’ll get results next week.
The reason for the test is a bit weak, IMHO. The cardiologist (whom I otherwise trust) said he saw some minor changes from last year’s regular stress test and wanted some comfort that all is well.
I’m on Flecainide, an anti-aFib med. But before I could go on it I had to get a calcification screen. At the MRI I asked the tech what was the range, and she said 0 to, theoretically, 10,000 or some such number.
I was expecting mine to be high, being 60+.
It was 2. Just 2.
Certainly not from eating right.
Yea, I was expecting around 150 myself because my dad had ithe same issues with this. But hey, I’m living healther than my dad I thought! So over 700 hits me hard because he had an angioplasty performed when he was in his late 50’s (damn he seemed old) and later stents after he had a heart attack in his late 60’s.
So damn, I could have drank a couple of bottles of whiskey and smoked two packs a day and still been where I am now, the same place as my dad.
My understanding as a consumer not as a physician - the calcium score is useful as an adjunct to other risk factors like LDL level. If someone’s risk score otherwise was near the edge of treatment or not the a high calcium score would push them over the edge. I don’t think it’s enough to place in a medication treatment category by itself. Of course lifestyle choices should be reviewed.
This was my problem – I have had high cholesterol for years, but no other risk factors (I’m active, not overweight, no history, non-smoker, etc.). The doctor said, fine, no statins, but just take a calcium test.
When that came back high, he sent me to a cardiologist who put me on statins.
I have the same understanding. It’s like being a bit overweight but an otherwise uncomplicated history: no chronics diabetes, hypertension, RA, cancer. It’s something the doc wants me to work on through lifestyle and wellness, another metric to target.
Well, I’m not just changing travel plans like I’m coming back in a couple of weeks. I’m looking to move there long term or permanently. If it was just a vacation I would just go and continue treatment when I returned.
But thats OK. I realize not everyone knows specifics about what I’m asking.
The point remains: the calcium score is generally used to stratify intermediate risk up or down. It is not a sign of imminent risk. Just a factor that may justify starting medication.
Now that chest pain? Independent of the calcium score that is what your doctor needs to decide what, if anything, to do about.
Cardiac CT scans are not that commonly used in Canada AFAIK^. They seem to be slightly better at estimating vascular health than carotid ultrasounds, which don’t use ionizing radiation. A lot of heart attacks happen in people with few risk factors - smoking, diabetes, high LDL cholesterol, low HDL cholesterol, concerning apolipoproteins, family history before age 60, obesity, etc. These scans are meant to help fill the gap. But I think they have some ways to go. They are usually scored with other risk factors. Cardiac CT scans might also expose the patient to 2 mSv of radiation per scan - a significant fraction of the background radiation in a year. Not tons, but cumulative radiation (especially in younger people) is always something to consider, especially in tests that are repeated.
An interesting 2019 study showed firefighters who could do forty pushups in one minute had a 96% lower risk of heart problems in the next ten years than those who could only do 10 pushups or less. This “quick office stress test” might be of more value?
^I’m sure a few specialty cardiac clinics would use them much more than ER or GP docs.
My great-aunt had calcium deposits around her heart. Apparently that was common in the midwest due to the hard water. She was in the hospital to undergo surgery the next day to repair some of the damage and a deposit finally wore away a hole in her aorta.
She was dead before a doctor could even get to the room.
I want to emphasize that neither my current cardiologist nor my previous one used the calcification score as a diagnostic tool. My previous doctor never even suggested it, and my current one only needed it as a mandatory evaluation before prescribing Flecainide (which apparently doesn’t play well with calcium buildup).
It was just a pass/fail on whether he could prescribe the aFib medication of choice, and it was never mentioned, before or after, as part of his evaluation of my condition.
So to me it doesn’t seem in widespread use as a diagnostic tool, but purely anecdotal.
My main concern is to give my doctor(s) time to evaulate the test results, run some some more test and try out new medication before heading off to another country for a prolonged period of time, and to keep working and using the “good” insurance while that is still an option.
If anyone wants to get this kind of test themselves, keep an eye out for cheap CT heart scans, like this one:
That’s amazingly cheap for a scan done by a multi-million dollar machine. I’m guessing it’s an easy way for hospitals to identify patient$ with profitable health i$$ues.
Every second that machine isn’t working they’re losing potential revenue. Just like the airlines, they’re happy to run last minute sales to fill seats that would otherwise go to waste. If they had more customers they would not be running these sales. We see that a lot here in South Florida where our summer population is ~25-30% less than in winter.
Having said that, there is money in what the industry calls the “worried well”. A little prospecting for those folks can pay dividends. To the shareholders.
