The examination can also be carried out on an outpatient basis. After being welcomed, you will fill out some documents and then be familiarised with the examination technique and the expected procedure during a detailed explanatory talk. Notable complications occur only very rarely given that the measure has been carried out many thousands of times. As a rule, an iodine-containing X-ray contrast medium must be given to show the coronary vessels during a cardiac CT. For better visualisation of the heart vessels, they are dilated with medication (nitrates). It may be necessary to slow down the heart rate by administering medication (beta-blockers) in order to further improve the image quality and, above all, to reduce the radiation exposure.

Because of the ECG and possible overlapping with denser clothing, the examination will be carried out with the upper body undressed; you may keep your glasses, watches, etc. and your skirt or trousers on. We kindly ask you to inform us about any intolerances before the examination. During the examination you should lie quietly and relaxed on your back. Please follow the instructions of the assistants if you then have to hold your breath for about 10 seconds.

The contrast medium is administered via a venous access in the area of the crook of the arm. During the administration of the contrast medium, a brief, intense feeling of heat may occur. This usually passes after a few seconds. The actual examination on the CT machine is completed within about 15 minutes. As long as the scanner is running, you are alone in the room, but you remain in constant contact with our assistants via an intercom system. This method is also suitable for patients with claustrophobia because, on the one hand, the modern CT machines have a very wide opening and, on the other hand, only part of the body is in the tube. About half an hour after the examination, the venous line will be removed from your arm.

Afterwards, we will discuss the results of the examination with you and you will receive printouts on paper as well as a DVD with data and pictures of your examination. From the admission to the discussion of the findings, you should expect a time requirement of about two hours.

The primary candidates for cardiac CT are men and women who do not have typical angina but do have other symptoms of coronary heart disease, especially those with an elevated cardiovascular risk profile. These include nicotine consumption, elevated blood lipids, elevated blood pressure, family history or diabetes mellitus. The examination can also be useful if other examinations, such as an exercise ECG or a cardiac scintigraphy, have produced unclear findings. It is also useful for checking the patency of bypasses after heart surgery.

Technical advances have led to an improvement in stent assessment, but for the time being definitive assessment of coronary artery stents by cardiac CT will tend to be limited to sections near the origin with a diameter of the stent from about 4 millimetres upwards.

Basically, there are only very few restrictions for cardiac CT. Less optimal image quality, with also higher dose values, is present in patients with irregular heartbeat (e.g. atrial fibrillation), with coronary stents (smaller than 4 millimetres in diameter) or morbid obesity (120 kg or more). In patients with contraindications to the administration of X-ray contrast media (e.g. in the presence of an allergy to contrast media, kidney damage or hyperthyroidism), particular care must be taken when determining the indication.

Please inform us at the time of making the appointment if there are any contraindications. However, the new system can also cope with lower amounts of contrast agent for good imaging. For women: no existing pregnancy (pregnant women are excluded from a cardiac CT because of the X-ray radiation).

Cardiac CT is very good at non-invasively ruling out disease of the heart’s arteries. This means that patients with an unremarkable cardiac CT result usually no longer need a cardiac catheterisation. Nevertheless, it can happen in individual cases that narrowing of the coronary vessels cannot be reliably graduated, e.g. in the case of arrhythmia, massive calcification in the coronary vessels or if the patient is severely overweight.

In these circumstances, you will be advised to undergo so-called stress imaging (stress MRI or stress scintigraphy) after the cardiac CT for further clarification if narrowing is in a borderline range from the graduation or is difficult to delineate from the topography. If the cardiac CT definitely shows coronary vessels that are too narrow, then a cardiac catheter examination is just as essential in order to be able to dilate them as if there is clear pain emanating from the heart or if there are other examination findings that very probably indicate a narrowing of the coronary vessels.

The radiation dose of cardiac CT depends on external factors (weight, heart rate and heart rhythm of the patient) and the examination technique used for this reason. As a rule, the radiation exposure of cardiac CT is no higher than that of a cardiac catheter examination and can even be significantly lower (approx. 1/3) under favourable circumstances. Patients with a slow and suitable heart rate can be examined with the turbo flash mode.

Here, the radiation exposure is particularly low and far below the annual natural radiation exposure. Please contact us if you have any further questions on this topic.

A calm and steady pulse is desirable for cardiac CT. You should therefore take all heart medication unchanged before the examination. There is no need to forgo a light meal before the cardiac CT. However, we would like to ask you to refrain from drinking coffee or black tea on the day of the examination. If you are diabetic and take a medication with the active ingredient metformin, please inform us when you make your appointment. So-called lifestyle drugs, such as preparations containing sildenafil, should also not be taken 24 hours before the cardiac CT.

To have a cardiac CT performed, you should bring current laboratory values with you, which provide information about your kidney and thyroid function as well as your metabolism:

• Creatinine value
• CRP
• Basal TSH value
• Lipid status: Total cholesterol, HDL, LDL, triglycerides

These values should not be older than 4 weeks. If you do not bring all the laboratory findings with you, these can also be determined in our clinic before the heart CT by taking a blood sample. However, this would involve a waiting time of about one hour, as this time is required for the evaluation of your blood values. The findings of previous examinations (e.g. stress ECG or operation reports) are helpful in the evaluation and assessment of a cardiac CT. We would therefore ask you to bring a copy of these findings or, if possible, a doctor’s letter with you.

No. The cardiac CT can be performed on an outpatient basis so that the patient can go home after the examination.

Our institute does not have health insurance approval for outpatients with statutory health insurance. Only patients with private insurance can receive a cardiac CT as an outpatient with adequate reimbursement. The examination has not yet been included in the scale of fees for physicians and is much more expensive than the computed tomography of the trunk of the body, which is usually reimbursed. The Institute’s invoices are based on a thoracic CT and the calcium score that is usually performed, with increased increment rates depending on the effort involved, in accordance with the fee schedule. In the vast majority of cases, there are no problems with reimbursement on the part of the funding agencies.

In most cases, we can give you a first result straight after the examination. You will receive colour prints of your heart and a DVD with the image data. We will usually send you or your GP the final written findings the following day.