What does an established coronary artery disease mean?

Coronary heart disease
Diagnostics & Therapy

Cardio CT and cardio MRI

Computed tomography of the heart (cardio CT)

We cooperate with experienced examiners for cardio CT examinations

Examinations of the heart and the coronary arteries can be carried out using the most modern X-ray diagnostics (multi-line spiral CT). Fast image acquisition and high resolution enable a three-dimensional representation of the heart.

The examination can assess the extent of calcification of the coronary arteries and, through the use of contrast media, also enable a direct visualization of coronary arteries or bypass vessels.

The examination is non-invasive, which means that there is no need to route a catheter through an artery to the heart. The contrast agent is administered through a vein. The radiation exposure of this X-ray examination has decreased in the last few years, but it can still be higher compared to the cardiac catheter examination.

Coronary calcification

Calcifications of the coronary arteries occur as a result of arteriosclerosis as a deposit of plaque material in the vessel wall and can be detected with the CT examination at an early stage (before narrowing of the vessels occurs) and its extent can be precisely assessed. The examination takes about 5 minutes; a contrast agent administration is not necessary for this. The radiation exposure of this part of the examination is not very high (similar to that of a long-haul flight).

The detection of coronary lime does not mean that there are already constrictions of the coronary arteries, which lead to circulatory disorders. However, an increased calcium content is associated with a significantly higher risk of myocardial infarction (even plaques that have not yet narrowed the artery can rupture and lead to vascular occlusion and subsequent myocardial infarction).

The consequence of increased calcium detection is the treatment of the controllable cardiovascular risk factors: arterial hypertension (high blood pressure), hypercholesterolemia (lipid metabolism disorder), nicotine consumption, diabetes mellitus (diabetes). The risk of a later heart attack or other vascular complications (e.g. stroke / apoplexy) can be reduced in this way.

If no coronary lime can be detected, the risk of coronary heart disease is low.

Depiction of the coronary arteries

Coronary arteries or bypass vessels can be visualized after injection of contrast medium into a vein in the arm. Prerequisites for a good assessment are: not too much calcification of the vessels and a regular heartbeat with a normal frequency (sinus rhythm). If the pulse is too fast, the heart rate may have to be lowered with medication.

A pulse of 60 beats / minute is aimed for. Heart rate lowering drugs can be given in tablet form or intravenously before the exam.

The examination allows an assessment of coronary arteries or bypass vessels with regard to the presence of a severe constriction (stenosis) or an obstruction. A three-dimensional reconstruction of the heart and coronary arteries can be made. The assessment of the patency of vascular supports (stents) is, however, also possible with restrictions.

Can cardiac CT replace a cardiac catheter examination?

The risk of a planned cardiac catheter examination by an experienced specialist in a corresponding center is very low. In suitable cases, a comparable statement can be obtained non-invasively, i.e. without access to the heart via an artery, in patients with a low risk of CHD.

Using the latest technology, cardio CT can in many cases replace a cardiac catheter examination. Diseases with severe stenoses or occlusions of the coronary arteries can be detected or excluded with great accuracy. For patients who have risk factors for coronary heart disease (high blood pressure, high cholesterol, nicotine consumption, diabetes, obesity, heart disease in the family), but who do not yet have a confirmed vascular disease, cardio-CT can provide a basis for any treatment that may be necessary. .

So far, slight or moderate changes cannot be classified as reliably. There are also limitations with regard to the ability to assess the conditions after the insertion of stents (vascular supports).

Cardio-CT is not an alternative to coronary angiography if a therapeutic measure is required (balloon expansion, stent implantation, bypass operation), i.e. if clear symptoms or findings already indicate the presence of higher-grade changes in the coronary arteries.

As part of the examination, the size and function of the heart chambers (cardiac output) and the nature of other arteries such as the main artery / aorta can be assessed and congenital heart defects can be identified. The use of cardiac CT makes sense if the conditions for an echocardiography are inadequate and magnetic resonance imaging cannot be used (e.g. after a cardiac pacemaker has been provided).

In contrast to private health insurances, the statutory health insurances usually do not yet cover the reimbursement of costs. Private health insurances reimburse the costs if medically correct indication. Since the total costs of the examination amount to several hundred euros, depending on the scope, it is advisable to clarify the cost assumption before the examination.

Representation of coronary vessels in a 3-D reconstruction