Cardiac Calcium Score Test

Cardiac calcium score also known as coronary artery calcium score is a unique diagnostic test to detect the incidence of coronary artery disease at an early stage. It also helps determine advanced stages of heart disease. This diagnostic test is recommended to determine the presence of calcium in the coronary artery. Coronary calcium score helps in prophylactic strategies such as administration of anti platelet therapy and cholesterol control methods respectively. Plaque is formed because of the deposition of fat in the coronary arteries. This plaque eventually get calcified leading to a condition called atherosclerosis.

Cardiac calcium score determination is based on comparison of profiles belonging to the same sex, age group and risk factor and history pertaining to coronary heart disease. The comparative parameters of the cardiac calcium scores are used to analyze the effects of the disease in relation to age and other risk factors.

Preparation for the cardiac calcium score test (CAC)

Cardiac calcium score is done by administering computer tomography technique. The procedure is non-invasive and detects the presence, location and level of calcium deposits in the coronary arteries. The patient is advised to reduce caffeine intake at least a few days prior to the test. Pregnant women are not advised to undergo this procedure.

The scores obtained are graded from 0 - 400. The patients having a CAC score of 1- 100 have mild evidence of coronary artery disease. Patients having a score of more than 100 are at moderate risk of cardiac disease and the patients having a score over 400 are at a greater risk of cardiac disease.

Dyspnea

Dyspnea is commonly known as breathing difficulty or shortness of breath. It is noticed as difficulty in breathing or labored breathing. Tachypnea refers to rapid breathing. Progressively it can lead to hyperventilation such as experienced during an anxiety attack. Studies indicate that the origin of dyspnea is initiated with inaccurate central nervous system to the lungs with respect to breathing.

The etiology of dyspnea is related to conditions such as Pulmonary Embolism (PE), asthma, COPD, pulmonary ischemia and pneumonia. The management of dyspnea is only effective when the underlying causes are treated. In case of trauma, pneumothorax is an acute trigger for initiating the onset of dyspnea and hence emergency care is given to prevent internal bleeding that is caused in the pneumothorax. This condition can also progress into tachypnea and varied lung and heart sounds which has to be managed with effective ER procedures.

Positional dyspnea: If a person suffers dyspnea when lying down, it might be suggestive of CHF or pericardial effusion.

Exertional dyspnea: This occurs when there is reduction in oxygen supply and is mostly noticed in patients suffering cardiac disease or anemia.

Transient dyspnea: This situation usually resolves without medical intervention and is triggered by reversible causes such as panic attacks.

Recurrent dyspnea: Here the patient suffers these episodes many times.

Conditions such as pulmonary embolism can also lead to dyspnea along with tachycardia and diminished breathing patterns. Dyspnea is an immediate progressive condition usually associated with previous history of trauma or illness such as Tuberculosis, bronchopneumonia, infectious mononucleosis and sepsis in certain scenarios. Since dyspnea is an associated condition and it is predominantly an upper airway obstruction, the treatment measures are often related to avoiding exposure to chemicals, pollen, toxic fumes and gases such as carbon monoxide. Diagnostic tools such as Pulse Oximetry, blood tests for anemia, ECG and metabolic study are used to aid the diagnosis and then initiate appropriate treatment.

Sumatriptan

Sumatriptan, part of the family of drugs called as triptans is prescribed for the treatment of Migraine and cluster headaches. Migraine headaches are thought to be the result of dilation of blood vessels in the head. Sumatriptan causes constriction of the blood vessels thus relieving Migraine. Triptans are technically abortive migraine medications. However, Sumatriptan does not prevent or reduce the number of migraine attacks. There is another 'triptan' drug which has slightly less side effects than Sumatriptan - Rizatriptan.

Dosage and Administration: Starting dosage may be 25 mg or at the discretion of the physician. However, the Physician might want the patient to take the first dosage at his office to monitor any adverse heart events. Normal dosage is 25 mg to 100 mg or as prescribed by the Physician. Maximum dose in any 24 hours should not exceed 300 mg orally. Do not use Sumatriptan concomitantly with Ergotamine containing preparations.

Safety and efficacy has not been proved for patients over 65 years or for children.

Contraindications: The use of Sumatriptan is contraindicated in hypersensitivity, ischemic heart disease or previous myocardial infraction, Prinzmetal's angina, coronary vasospasm and controlled hyper tension. Sumatriptan should not be used unless there is a clear diagnosis of Migraine. Before use, exclude underlying cardiac disease especially in patients with risk factors. Chest symptoms may occur which mimic angina but are rarely found to be the result of vasospasm. Vasospasm may result in arrhythmia, ischemia or myocardial infarction. This drug is to be avoided for patients with impaired renal or hepatic functions.

Sumatriptan should not be administered along with ergot type migraine medications, or with MAO inhibitors. Sumatriptan and Ergotamine together can cause prolonged spasm of the blood vessels. It is essential that the use of these two medications should be separated by at least 24 hours.

Side Effects of Sumatriptan: Pain, tingling sensation, heaviness or pressure in the chest region which may be transient. Rarely severe flushing, dizziness, Paresthesia ( unpleasant and abnormal tingling or burning in the hands, arms, feet or legs) weakness, fatigue, drowsiness may occur. Transient rise in blood pressure may occur.