#46: Chest pain, coronary CT angiography, and coronary artery disease

Master the evaluation of acute and chronic chest pain with coronary CT angiography (CCTA). We deconstruct this game changing technology w/experts from the Society for Cardiovascular Computed Tomography (SCCT), Dr. Todd Villines and Dr. Ahmad Slim. We’ve got answers on what to do when a patient with chest pain has a prior CAC score of zero, and/or a CCTA with non-obstructive disease. Plus: how to select, prepare, and counsel patients; how to interpret reports; choosing between myocardial perfusion study and CCTA, and more! Special thanks to Dr. Emilio Fentanes from SCCT for setting up this interview. Full show notes available at http://thecurbsiders.com/podcast Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at [email protected]. Case: 45 yo F active duty Colonel with chronic chest pain syndrome despite negative conventional stress test and CAC score of zero. Time Stamps 00:00 Intro 04:00 Rapid fire questions 08:23 Book recommendations 10:14 Defining terms CCTA vs CAC 12:47 Script for counseling patient about CCTA 14:34 Prep for CCTA 16:40 Why is CCTA controversial? 19:37 Patient selection for CCTA both acute and chronic 25:20 Chronic chest pain and CCTA 27:58 CAC and CCTA in high risk occupations 33:25 Clinical case 36:10 Acute chest pain in patient w/CAC score zero 39:18 Acute chest pain in patient w/CAC score zero and previous CCTA w/non-obstructive CAD 41:22 How to read a CCTA report 45:48 CCTA versus conventional testing and risk MI, death 49:18 Use of CCTA in outpatients 52:16 Plaque characteristics and risk ACS 55:51 CCTA w/non-obstructive disease in patients with acute chest pain 58:14 When is myocardial perfusion scanning better? 61:00 Listener question on small vessel disease 62:09 Take home points 65:00 Curbsiders recap 69:33 Outro