Coronary Computed Tomography Angiography and HeartFlow Analysis

Coronary computed tomography angiography (CCTA) is a noninvasive heart imaging test that generates three-dimensional (3D) images of your heart, coronary arteries and great vessels.

During the test, you will receive standard iodine-containing contrast material as an intravenous (IV) injection to help obtain better images. The scan is acquired seconds after the contrast is administered, in which x-rays pass through the body and are sensed by detectors in the scanner to produce high-quality 3D images.

If more details are needed to assess your coronary arteries, a HeartFlow analysis may be ordered. This analysis uses your CCTA scan (no additional imaging required) to provide further information for your doctor.

You may have a CCTA as an outpatient appointment or as part of your stay in the hospital. This test may be done for:

• Stable or acute chest pain syndrome
• Suspected or known coronary artery anomaly
• Preoperative evaluation
• Alternative to invasive angiography
• Assess patency of bypass graft
• Abnormal stress test

Benefits include:

• Compared to a cardiac catheterization (which is invasive), a CCTA is noninvasive and decreases the risk of vascular injury, stroke and myocardial infarction (heart attack), requiring less patient recovery time
• Scan takes approximately 20 to 30 minutes
• Provides detailed images of the heart with less contrast compared to a cardiac catheterization
• Can detect or exclude plaque in the coronary arteries, which helps guide medical therapy

Risks include:

• Allergic reaction to the contrast dye, which are usually mild and easily controlled by medication. Tell your technologist if you have ever had a reaction to contrast dye, or if you have a history of kidney problems.
• Radiation exposure
• Inform your technologist if you are pregnant, think you may be pregnant or are breastfeeding

• Make a list of any questions and discuss with your doctor before the procedure. Consider bringing a family member or trusted friend to the appointment.
• You may eat solid food up to three (3) hours before your test. You may drink clear liquids before the test.
• Take your daily medications as directed. If you are diabetic, follow instructions from your doctor regarding your insulin or oral hypoglycemic medication.
• Your doctor may order a beta-blocker medication to take one to two hours prior to your test. The beta-blocker will help lower your heart rate and obtain optimal images of our heart.
• Tell your doctor if you are allergic to iodinated contrast dye, if you are pregnant or breastfeeding, or if you have a history of kidney problems, diabetes or asthma.
• On the day before and the day of your test, avoid caffeinated drinks (coffee, tea, energy drinks, soda), smoking or nicotine products, energy or diet pills, Cialis, Viagra, Levitra, or any other drugs that are contraindicated to nitroglycerin.
• Obtain lab work ordered by your doctor before your test.
• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.

Be sure to tell the technologist if you have ever had a reaction to contrast material, if you are pregnant or think you may be pregnant.

Wear comfortable, loose-fitting clothes to your test. You may be asked to remove your clothing, any metal objects (jewelry, bobby pins, eyeglasses, etc.) which may affect CT images, and be given a gown to wear.

The technologist or nurse will place an intravenous (IV) catheter in your hand or arm. Contrast material used in the CCTA will be injected through the IV during the scan.

During the CCTA, you will be positioned on an examination table. Your heart rate and blood pressure will be monitored during the test. The nurse may administer a beta-blocker medication to help lower your heart rate and nitroglycerin tablet to help dilate your coronary arteries.

The technologist will give you breathing instructions. You will hold your breath for short periods of time and be asked to remain perfectly still.

The CCTA scan takes approximately 20 to 30 minutes. While in the scanner, the technologist will be able to see, hear and speak with you using a two-way intercom.

A cardiologist or radiologist will interpret your CCTA scan and provide a report to your referring or primary doctor. A follow-up appointment with your doctor may be necessary to review the results of your scan. If contrast material was used during your CCTA scan, you may be watched for a period of time for any reactions. These include itching, swelling, rash or trouble breathing.

Contact your doctor if you notice any pain, redness or swelling at the IV site after returning home. These could be signs of an infection or other type of reaction.

You may resume your usual diet and activities unless your doctor tells you differently.