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Coronary Calcification & Stress Testing: What you need to know

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Stress Test

Coronary artery disease (CAD) is often called the silent killer. While it’s the most common heart-related disease in both men and women, most people aren’t aware they have CAD until it presents in a catastrophic way, such as a heart attack. 

Wouldn’t it be nice to be able to scan the body and find out if you have plaque building in your arteries? There is a procedure that allows for this, and it’s called a coronary calcium scan. A coronary calcium scan takes x-ray photos of the heart and determines the level of coronary calcification, or hardened plaque, in the heart’s arteries. 

While a coronary calcification test sounds like a good idea, there are many things to consider when deciding if this is the right procedure for you. Namely, how will the course of treatment change once you’ve obtained the results of your heart scan?

Understanding the purpose of a coronary calcium scan

Coronary artery disease is dangerous. CAD occurs when fat, cholesterol, calcium, and other waste builds up in the arteries. Also referred to as plaque, this waxy build-up is the leading cause of atherosclerosis, a condition that narrows the arteries and blocks oxygen-rich blood from reaching the heart. 

Narrowed arteries block vital blood flow to the heart muscle, causing it to weaken over time. Untreated CAD can lead to heart failure, a life-threatening condition in which the heart doesn’t pump blood as effectively as it should. Alternatively, it can lead to a heart attack.

While some plaque hardens, or calcifies, in the arteries, others remain soft. When plaque ruptures from the artery wall, it typically creates a clot. If this clot becomes lodged in the heart, blood flow is interrupted, and a heart attack occurs. 

In an effort to quantify how much risk an individual has for CAD, the coronary calcium scan was developed. This short 10-minute procedure takes x-ray photographs of the heart through a CT scanner. 

After the procedure, patients are given a calcium score, also sometimes called an Agatston score. This score is calculated based on how much plaque is visible in the arteries. Doctors then make recommendations based on the score severity. 

Coronary calcium scan result recommendations 

A coronary artery calcium scan estimates the likelihood of obstructive coronary artery disease. Depending on the results, cardiologists may make several recommendations, including: 

Lifestyle modifications

Depending on the coronary calcium scan results, some physicians may recommend lifestyle modifications. For example, smoking is a significant risk factor for CAD, as are obesity, physical inactivity, and eating an unhealthy diet. 

Doctors may recommend that individuals with low to moderate coronary calcification test scores make lifestyle modifications to lower their risk. 

Medications, such as statin therapy 

The primary use of coronary calcium scoring is to guide physicians to start patients on pharmaceutical drugs, such as statins. Approximately 35 million Americans currently take statins with the hope of reducing cholesterol levels and minimizing cardiovascular risk. 

Unfortunately, evidence does not exist to show that statins are helpful. Not only do studies show minimal benefit to statin use, some research finds an increased risk of death for those who take statin drugs. Moreover, studies find statins increase coronary calcification rather than decrease it. As such, prescribing statins due to high coronary calcium scores is not beneficial. 

Further testing, such as a cardiac stress test

Individuals who receive high coronary calcification test scores are sometimes referred to for a cardiac stress test.  A cardiac stress test, also called an exercise stress test, measures the heart’s function and blood flow while it works hard.

While stress tests have value, they are best utilized for individuals with symptoms. For example, an individual who experiences chest discomfort while walking up a flight of stairs might benefit from a stress test. However, most people with abnormal coronary calcium scans are asymptomatic. 

Cardiac stress test vs. coronary scan 

A coronary artery scan is a passive test completed with the patient lying down. X-ray images are taken and viewed to evaluate for coronary calcification.

On the other hand, a cardiac stress test is a functional test typically performed on a treadmill or with drugs that mimic physical movement. During a cardiac stress test, individuals are connected to an EKG machine and a blood pressure monitor while the heart works progressively harder. Abnormalities in the blood pressure, heart rate, or any worsening physical symptoms point to the possibility of coronary artery disease. 

It’s also important to note that stress tests are not always an accurate risk indicator. For example, in 2004, former President Bill Clinton passed his cardiac stress test and experienced a heart attack just weeks later. Countless others have had the same experience. 

Invasive procedures such as cardiac catheterization and stents

In some cases, if the results of a heart scan show significant coronary calcification, it often leads to more invasive procedures, such as cardiac catheterizations and stents. 

Unfortunately, studies show that stents do not reduce the risk of death, heart attack, or other major cardiovascular events. Research shows that stents are not necessarily effective in reducing symptoms or improving exercise tolerance in most patients. Stents are helpful only for those having an active heart attack. 

According to a 2015 JAMA article, nearly 80 percent of stents placed for coronary artery disease are unwarranted according to current guidelines. While it seems counterintuitive, coronary artery blockages should not be fixed unless significant symptoms impact one’s life. 

The best way to keep your arteries clean 

Coronary calcium scans, stress tests, and cardiac catheterizations are diagnostic procedures often used in the medical field. While they may give us a small glimpse into the heart, they often don’t tell the whole picture. 

Regardless of the outcome of these diagnostic procedures, the best way to keep arteries clean and running smoothly is to eat well and live well. Choose organic, whole foods. Move your body often. Spend time in the sunshine and nature. Get quality sleep. Find joy throughout your day.

Next Steps

If you’ve had a diagnostic procedure and want help determining the next best steps, consider working with one of our experienced health practitioners. Together you can review your results, discuss your risk factors, and make a plan to achieve your 100 year heart. 

  • If you would like to learn more about CAD, click here.
  • If you would like to learn more about our coronary artery disease supplement protocol, click here.
  • If you would like to discuss your heart issue with one of our practitioners, click here (20 minute consult).

Eat well, Live well, Think well


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About Dr. Jack Wolfson DO, FACC

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Frequently Asked Questions

I’d like to receive an online second opinion from Natural Heart Doctor. What do I do next?

You can initiate a second opinion online through our website at any time. To begin, select the team member you’d like to speak with and open an account.

Click here for cardiologist Dr. Jack Wolfson.

Naturopathic Medical Doctor Dr. Lauren Lattanza. Get details.

Naturopathic Medical Doctor Dr. Tonia Rainier. Get details.

Click here for  Natural Heart Doctor Health Coach.

Alternatively, you can email health@naturalheartdoctor.com. A member of our care team will help guide you through the process of starting a second opinion.

What is the cost of a Natural Heart Doctor Online Second Opinion?

The cost for most second opinions varies by team member. This fee includes information collection, a phone or video consultation, a second opinion from a Natural Heart Doctor specialist and guidance throughout the process from your personal Care Team at Natural Heart Doctor.

Cardiologist Dr. Jack Wolfson’s Second Opinion Fee is $1500.

Holistic Physician’s Dr. Lauren Lattanza’s Second Opinion Fee is $250.

Naturopathic Physician Dr. Tonia Rainier’s Second Opinion Fee is $250.

Note: We apply the Online Second Opinion Call fee as a credit to any future consultations with Natural Heart Doctor, should you choose them.

Will my insurance cover the cost of a Natural Heart Doctor Online Second Opinion?

Most likely, no. Most health plans do not cover online second opinions or consultations. You are responsible for the cost of our second opinion. Natural Heart Doctor cannot file a claim with your insurance carrier, nor can we provide a procedure (CPT) code for this service.

What is the timeline to receive an online second opinion?

We do our best to schedule your second opinion as quickly as possible. Typically, it takes 5 to 7 business days after your information has been collected to receive your phone or video online second opinion.

What information do you need in advance of our call?

Our office will send you a short questionnaire to complete and return. We DO NOT need your complete medical records.

How many questions can I ask the expert during our call?

You may ask a maximum of five questions. This is to ensure that the expert has sufficient time to devote to each question. All questions must be finalized before your online meeting.

What should I expect to receive once my second opinion is complete?

You will receive a summary of our discussion along with our second opinion. The second opinion will be in written form. After you have reviewed the second opinion, a Natural Heart Doctor clinician will follow up with you by phone to address general medical questions about the information provided in the second opinion.

What if I have follow-up questions for the expert after I have reviewed my second opinion?

If you have a clarifying question about an expert’s response to one of the questions in your second opinion, and the Natural Heart Doctor clinician is unable to address it, then you may request a follow up session for an additional fee. 

Is my medical and payment information secure?

Natural Heart Doctor is strongly committed to protecting the privacy and security of all our patients. Our website meets all federal requirements for protecting personal health information under the Health Insurance Portability and Accountability Act (HIPAA). All financial transactions are processed by Natural Heart Doctor securely using industry standard payment processing tools.

I would rather visit Natural Heart Doctor for an in-person appointment. What should I do next?

If you would prefer an in-person appointment at Natural Heart Doctor instead of an online second opinion, please call (480) 535-6844 for details and scheduling.

Can I schedule a follow up appointment with the specialist who provided my online second opinion?

Yes, we’re happy to help you on an extended basis. Our clinician can discuss options with you when presenting our second opinion summary.