Cardiac / Coronary CT Angiography is a non-invasive examination that provides highly detailed images of the entire coronary arterial tree, the heart chambers, the heart valves and the aorta, supporting highly accurate diagnoses. Cardiac CT Angiography involves the intravenous administration of a contrast agent.
In certain cases, this exam may be complemented with a Cardiac CT Calcium Score, which focuses on detecting calcified deposits in the coronary arteries, serving as an indicator of atherosclerosis.
What is Coronary CT Angiography and what is it used for?
Cardiac / Coronary CT Angiography uses X-rays and an intravenously administered iodinated contrast agent to produce detailed images of the heart and coronary arteries.
The images are acquired in synchronisation with the electrocardiogram, reducing the effects of cardiac motion. They can then be reconstructed in different planes and in three dimensions, allowing the radiologist to assess the origin, course and calibre of the arteries.
The examination is mainly used to assess the presence of atherosclerotic plaques, determine whether narrowing or blockages are present, and examine the coronary anatomy. It may help rule out significant coronary artery disease in certain patients and, in selected situations, avoid the need for invasive coronary angiography. However, it is essentially a diagnostic examination: an angioplasty cannot be performed and a stent cannot be inserted during the same procedure.
What is the price of Cardiac / Coronary CT Angiography?
The price of Cardiac / Coronary CT Angiography when performed privately is €250.
However, the examination may also be performed through several agreements, including:
- SNS / ARS: When Cardiac / Coronary CT Angiography is performed through the Portuguese National Health Service, the patient does not pay any amount. A referral from the Health Centre must be presented;
- Protocols: NRD has protocols with several clinics and institutions that allow patients to undergo the examination at highly competitive prices. Under these protocols, the price of this examination is €200.
How is it performed?
The patient lies on a table that moves through a circular scanner. Inside the scanner, an X-ray tube rotates rapidly, emitting X-ray beams that pass through the patient’s body. These beams are captured by advanced detectors that produce multiple cross-sectional images of the cardiac anatomy. Our equipment processes 128 slices simultaneously.
To ensure that the computer-generated three-dimensional images are as clear as possible, it is essential to control the heart rate, which should ideally be between 50 and 60 beats per minute. For this reason, the examination requires continuous blood pressure and electrocardiogram monitoring. A beta-blocker is commonly prescribed beforehand to slow the heart rate.
What can it detect?
Cardiac / Coronary CT Angiography provides a detailed anatomical assessment of the coronary arteries. It may detect:
- Calcified, non-calcified or mixed atherosclerotic plaques, including changes that have not yet caused a marked reduction in the arterial lumen;
- Coronary stenoses, meaning areas where an artery is narrowed to a potentially significant degree;
- Complete blockage of an artery and the extent of coronary artery disease across different vessels;
- Congenital abnormalities affecting the origin or course of the coronary arteries, which may only be identified through a detailed anatomical assessment;
- The patency of coronary bypass grafts and, in selected cases, the assessment of coronary stents. Accuracy may be limited by the small diameter of the stent, the metallic material or the presence of calcification;
- Abnormalities of the heart chambers, pericardium, aorta and other structures included within the imaging field.
Cardiac CT Angiography primarily shows the anatomy of the arteries. The effect of a stenosis on blood flow or on the blood supply to the heart muscle may require additional assessment with functional examinations, depending on the cardiologist’s decision.
When is it recommended?
The indication should be determined by the referring physician, taking into account the patient’s symptoms, cardiovascular risk factors, results of other examinations and clinical probability of coronary artery disease.
Cardiac / Coronary CT Angiography may be recommended in situations such as:
- Investigation of chest pain or discomfort when coronary artery disease is suspected, particularly in people with a low or intermediate clinical probability of coronary obstruction;
- Persistent or recent symptoms requiring clarification of a possible cardiac cause, including some cases of shortness of breath;
- Inconclusive, uncertain or conflicting results on electrocardiograms, exercise stress tests or other cardiac examinations;
- Suspected abnormal origin or course of the coronary arteries;
- Assessment of coronary bypass grafts and, in selected cases, coronary stents;
- Planning of certain structural heart procedures, such as transcatheter aortic valve implantation;
- Additional assessment of abnormalities of the heart, aorta or great vessels identified on other examinations.
In patients without symptoms, Coronary CT Angiography should not be used indiscriminately as a screening examination. The decision depends on the patient’s individual risk and the clinical question that needs to be answered. For preventive risk stratification, a Calcium Score may be more appropriate in certain cases. Current European recommendations support the use of Coronary CT Angiography in the diagnosis of obstructive coronary artery disease in selected patients with suspected chronic coronary syndrome.
Cardiac / Coronary CT Angiography with Contrast
Coronary CT Angiography is usually performed with intravenous iodinated contrast. The contrast circulates through the bloodstream and makes the inside of the arteries visible, allowing their calibre to be assessed, “fatty plaques” to be identified and any areas of narrowing to be located.
The injection may cause a temporary sensation of warmth, particularly in the face, neck or pelvic region. Some people also report a metallic taste, mild nausea or an urge to urinate. These sensations usually disappear quickly.
Allergic reactions are uncommon, but they may occur. Before the examination, you must inform the team if you have previously experienced a reaction to iodinated contrast, if you have asthma, kidney or thyroid disease, or if you take metformin, which must be discontinued 48 hours before the examination.
When there is a relevant contraindication to contrast administration, the physician may consider a different imaging method. A non-contrast CT scan does not, by itself, provide the same detailed assessment of the inside of the coronary arteries.
Preparation for Cardiac / Coronary CT Angiography
Please arrive at the clinic approximately 30 minutes before your scheduled appointment. You should bring the following:
| Topic | Instructions |
|---|---|
| Medical History and Previous Examinations | Bring recent clinical reports and cardiac imaging examinations, such as echocardiograms, electrocardiograms, magnetic resonance imaging scans, previous CT scans or cardiac catheterisation records. If you have previously undergone heart surgery, please also bring the relevant discharge summaries or surgical reports. |
| Kidney Function Assessment | You are advised to bring recent blood test results showing your serum creatinine level. This result is essential and mandatory for patients with a history of kidney disease or diabetes, in order to ensure that the contrast agent can be administered safely. |
| Safety Screening | Before the procedure, you will be asked to complete a questionnaire concerning your medical history and any known allergic reactions, particularly reactions to iodinated products. |
| Metal Objects | We recommend wearing comfortable clothing without metal components, such as zips, metal buttons or accessories. Jewellery, watches and piercings must be removed before entering the examination room, as they may cause artefacts and reduce image quality. |
To ensure the safety of the procedure and the best possible image quality, please follow the instructions below carefully.
| Topic | Instructions |
|---|---|
| Discontinuation of Specific Medicines — 48 hours before the examination | Erectile dysfunction: Stop taking medicines such as sildenafil, tadalafil, vardenafil or avanafil. These are strictly incompatible with the vasodilator medication that will be administered at the clinic.
Diabetes — metformin: Stop taking oral antidiabetic medicines containing metformin. |
| Food Restrictions and Fasting — 4 hours before the examination | Do not eat any solid food for at least four hours before the examination.
You may, and are encouraged to, drink small sips of water or clear, sweetened liquids without pulp, such as filtered juice. |
| Heart Rate Control — 6 to 12 hours before the examination | Avoid smoking and consuming stimulants, including coffee, black or green tea, caffeinated soft drinks and energy drinks, for 6 to 12 hours before the examination. Your heart rate should remain as low and stable as possible. |
| Usual Medication and Medicines Used During the Examination | On the day of the examination, take your usual medicines with water at the normal times.
Exception: If you regularly take beta-blockers such as atenolol, propranolol, carvedilol, bisoprolol or nebivolol, confirm with the team in advance whether you should stop taking them, to avoid an additive effect with the medication that will be provided at the clinic. During the examination: You may be given a beta-blocker to reduce your heart rate. Sublingual nitroglycerin will also be administered to dilate the coronary arteries and improve their visualisation. |
| Mandatory Medical Warnings | Inform the clinical team immediately if you have asthma, a history of arrhythmias, kidney failure or raised urea or creatinine levels, or any type of allergy. |
| Care After the Examination | After the CT examination, significantly increase your water intake throughout the day to help your kidneys eliminate the contrast agent more quickly. |
Instructions during the examination
Your cooperation is important to reduce movement and obtain images that are sufficiently clear for a reliable assessment of the small coronary arteries.
During the procedure, you may be instructed to:
- Remain still while the images are being acquired;
- Keep your arms in the position indicated by the clinical team, usually above your head;
- Breathe in and hold your breath for a few seconds when instructed;
- Avoid speaking or moving during image acquisition, even if the scanner appears to have stopped;
- Inform the team immediately if you experience shortness of breath, itching, dizziness, pain, discomfort or any other unexpected symptom after the administration of contrast or medication.
The radiographer will maintain visual contact with you at all times and will be able to communicate with you through the scanner’s intercom system.
When and how will you receive the results?
You will receive the CT results within seven days of the examination, either by email or as a printed copy at the clinic. On the day of the examination, you will be given a CD containing the images.
Where can CT Coronary Angiography be performed?
Cardiac / Coronary CT Angiography can be performed at NRD at the following address: Avenida Columbano Bordalo Pinheiro, no. 11-B, ground floor, 1070–060 Lisbon (Next to Praça de Espanha)