The Silent Cry of the Myocardium: How CT Coronary Angiography Is Redefining Heart Health

Writer: Prof. (Dr.) Rajul Rastogi
Department of Radiodiagnosis
Teerthanker Mahaveer Medical College & Research Centre
Moradabad, Uttar Pradesh – 244001

Introduction: A New Reality of Heart Disease in India

For decades, myocardial infarction was largely associated with advancing age, typically affecting individuals in their seventh or eighth decade of life. However, contemporary clinical practice reveals a deeply concerning shift. Increasingly, heart attacks are being diagnosed in individuals in their 30s and 40s, striking at the economic and emotional core of Indian families.

When a young earning member experiences a cardiac event, the consequences extend far beyond the hospital walls. This emerging pattern of “young myocardial infarctions” highlights the urgent need to move away from reactive cardiac care and adopt integrated diagnostics with proactive screening as a standard approach to heart health.

Modern Lifestyle and Its Impact on the Heart

The rising incidence of premature coronary artery disease is closely linked to lifestyle-related risk factors that have become deeply embedded in modern living. This evolving epidemic can be understood through three interrelated threats to cardiovascular health.

Physical Inactivity and Sedentary Behaviour

The transition to desk-based occupations and digital dependency has significantly reduced daily physical activity. This sedentary pattern impairs metabolic efficiency, contributing to poor lipid metabolism and insulin resistance, both of which accelerate vascular damage.

Chronic Stress and Cardiovascular Strain

High-pressure professional environments, constant digital connectivity, and sustained psychological stress result in prolonged activation of the sympathetic nervous system. Elevated cortisol levels and chronic inflammation exert a damaging effect on coronary arteries over time.

Dietary Imbalance and Metabolic Dysfunction

The increasing reliance on ultra-processed foods rich in trans fats, refined sugars, and low nutritional value has displaced traditional balanced diets. This shift promotes dyslipidaemia, systemic inflammation, and early plaque formation within coronary vessels.

Although age remains a non-modifiable risk factor, these lifestyle elements collectively contribute to the premature ageing of the heart.

Understanding the Biology of a Heart Attack

Irrespective of external triggers, the underlying mechanism of most heart attacks is atherosclerosis. The heart muscle relies on a continuous supply of oxygen-rich blood delivered through the coronary arteries. Over time, low-density lipoprotein (LDL) cholesterol accumulates within arterial walls, forming plaques.

As plaque burden increases, blood flow becomes restricted. While this may remain asymptomatic at rest, physical exertion or emotional stress increases myocardial oxygen demand. When narrowed arteries fail to meet this demand, the myocardium experiences ischaemia, clinically manifesting as angina.

Plaque rupture can abruptly occlude blood flow, resulting in myocardial infarction and irreversible loss of heart muscle tissue.

CT Coronary Angiography: A Paradigm Shift in Cardiac Imaging

Traditionally, visualisation of coronary arteries required invasive catheter-based angiography involving arterial puncture and hospital admission. While effective, this approach carries procedural risks and patient discomfort.

CT Coronary Angiography (CTCA) has transformed cardiac diagnostics by offering a non-invasive, outpatient-based alternative that delivers detailed anatomical and functional insights.

How CT Coronary Angiography Works

CTCA involves intravenous administration of a non-ionic, iodinated contrast agent through a peripheral vein. A high-speed CT scanner then acquires thousands of images within a few cardiac cycles, generating a precise three-dimensional reconstruction of coronary anatomy.

This approach eliminates the need for arterial access while maintaining diagnostic accuracy.

Diagnostic Advantages of CT Coronary Angiography

CTCA extends beyond simple detection of blockages and provides a comprehensive evaluation of coronary health.

Coronary Calcium Scoring

Calcium deposition within coronary arteries serves as an early marker of atherosclerosis. The coronary calcium score is a validated predictor of future cardiovascular events, often identifying risk years before symptom onset.

Plaque Characterisation

CTCA differentiates between stable, calcified plaques and vulnerable, lipid-rich plaques. Identifying high-risk plaques enables timely intervention before catastrophic events occur.

Post-Intervention Assessment

In patients who have undergone angioplasty or bypass surgery, CTCA allows non-invasive assessment of stent patency and graft integrity, reducing the need for repeated invasive procedures in most cases.

Advanced Imaging at Teerthanker Mahaveer Hospital

The Department of Radiodiagnosis at Teerthanker Mahaveer Hospital is equipped with a 160-slice dual-energy CT scanner, representing the forefront of cardiac imaging technology.

High slice capability enables rapid image acquisition, minimising motion artefacts even in patients with elevated heart rates. Dual-energy imaging overcomes limitations such as calcium blooming, ensuring accurate evaluation of the coronary lumen and stenosis severity.

Low-dose radiation protocols further enhance patient safety without compromising diagnostic precision.

Patient-Centric Care with CTCA

CT Coronary Angiography at TMH is designed to prioritise patient comfort and convenience. The procedure is conducted entirely on an outpatient basis, with no requirement for hospital admission or prolonged recovery.

Patients can resume routine activities shortly after the scan, benefiting from rapid reporting and expert interpretation that guides personalised treatment planning, ranging from lifestyle modification to interventional or surgical management.

Conclusion: Advancing Towards Preventive Cardiac Care

As India progresses towards sustainable development and improved public health outcomes, addressing premature heart disease is a national imperative. The integration of advanced imaging with preventive strategies offers a powerful solution.

CT Coronary Angiography empowers individuals with actionable knowledge about their cardiovascular health. By enabling early detection and risk stratification, it shifts the focus from crisis management to prevention.

Listening to the subtle warnings of the myocardium and embracing modern radiological solutions can safeguard not only individual lives but the stability of families and communities.

Frequently Asked Questions on CT Coronary Angiography

Q: What is CT Coronary Angiography?

Ans: It is a non-invasive CT-based imaging technique that visualises coronary arteries using intravenous contrast, without the need for catheter insertion.

Q: Is the procedure painful?
Ans: No. The test is similar to a routine CT scan, involving only a minor intravenous injection.

Q: Is hospital admission required?
Ans: No. CTCA is performed as a complete outpatient procedure.

Q: How does it differ from conventional angiography?

Ans: Traditional angiography involves arterial catheterisation, whereas CTCA uses external imaging technology and advanced computational analysis to assess coronary arteries.

Q: Who should consider CTCA?

Ans: Individuals with atypical chest pain, a family history of heart disease, high occupational stress, or those seeking a baseline cardiac risk assessment may benefit from CTCA.