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The Curbsiders Internal Medicine Podcast

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

The Curbsiders Internal Medicine Podcast

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.83.1K Ratings

🗓️ 3 July 2017

⏱️ 69 minutes

🧾️ Download transcript

Summary

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

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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

Transcript

Click on a timestamp to play from that location

0:00.0

Welcome back to the Curbsiders.

0:07.0

Well, hello, Matthew. How are you doing? I'm okay. I'm okay. I'm a bit tired. I've

0:19.0

moved to the East Coast steward, so it's quite late here right now as we are recording this

0:23.5

intro after a very long and informative conversation. Paul, Paul, we're sorry that your

0:30.5

connection dropped out halfway through this or less than halfway through this. I don't

0:35.9

know when. How are you doing? I'm great. Yeah, I could hear everything just fine. So I got

0:40.5

a lot out of this. I just had as per usual, not much to contribute. So it's not much has

0:45.0

changed for me. So for me, this is a fantastic episode. Well, thanks, Paul. Okay. Well, we weren't

0:50.5

all going to give our picks of the week, but I know steward had a very special pick of

0:55.7

the week that he wanted to talk about. Oh, that was amazing. Yes. So the facility that I work

1:02.6

in is trying to save money. And so when I went to go use the restroom, I noticed that they

1:07.7

installed some some type of security measure on the toilet paper. You can only take two

1:12.2

squares of single-ply toilet paper. So my pick of the week is two squares of single-ply

1:17.1

toilet paper. And this is no more. You work at cashlack memorial hospital. Is that correct?

1:23.1

It is definitely cashlack. Well, so it's not a misnomer. No, not this time. Definitely

1:31.1

lacking cash. Okay. I have absolutely nothing. I the wheels are spinning and I got nothing

1:37.3

for it. I mean, I could I could I could recommend plenty of things, but I'll save it. Stewards

1:43.9

pick was so good that I think the audience that's that's all they need. I did want to introduce

1:49.3

this episode. First, I wanted to thank Dr. Emilio Fentanez, whose last name I most surely mispronounced

1:56.3

because that's my thing. But Emilio, thank you so much for setting this up. Emilio works for

2:01.5

he is a cardiologist and he is part of the society for cardiovascular computed tomography

2:07.5

also known as the SCCT and they are having their 12th annual meeting in July. And this

...

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