DR. GREGORY SZTO MBBS, FRACP, FCSANZ, FSCAI, FACC Tel: 03 9789 0088 Consultant & Interventional Cardiologist Fax: 03 9789 8866 Suite 11, Peninsula Private Hospital Melway Ref 103 D6 525 McClelland Drive FRANKSTON 3199 Email: gsoffice@bigpond.com *** The CT scanning procedure is performed at MIA Radiology, PPH. Tel: 03 9776 7106***

CARDIAC CT SCAN REQUEST FORMCARDIAC CT SCAN REQUEST FORM ☐☐Complete Scan Complete Scan ☐☐Calcium Score onlyCalcium Score only

Name:………………………………………………………………………

Address: ……………………………………………………………………

Birthdate:…………………………. Phone:………………………

Take Metoprolol ____mg at ______, date______ and_____ mg at_____, date______ CT Scan Date:________________________________________Time:_________________

*** NOTE: Cardiac CT scanning is performed at MIA Radiology, PPH*** Follow-up Appointment Date: Time:

Indication for Cardiac CT (please circle whichever is/are relevant) 1. Chest pain or shortness of breath of indeterminate cause 2. Equivocal stress test, unable to have stress test 3. Determine cause of chest pain after bypass surgery or stent 4. Exclude ischaemic heart disease in high-risk individuals 5. Suspected congenital heart disease or anomalies 6. Assess cardiomyopathy or pericardial disease 7. Cardiac anatomy (LA, PV, coronary sinus pre-EP/pacemaker) 8. Pre-operative evaluation 9. Other:

Copies to: Requesting Doctor’s Details: Name: Date: Address: Provider No: Signature:

Please fill in the details prior to arrival: Clinical Details Yes No High blood pressure (> 140/90 mmHg or on treatment) High cholesterol (> 5.5 mmol/L or on treatment) Diabetes, if yes: Type 1 or 2 (adult onset) (IGT ☐yes ☐no) Smoker (Prior smoker ☐yes ☐no) Family history of premature heart disease? Father AMI < 55 yrs, Mother AMI < 50 yrs

Abnormal/Equivocal stress test Previous heart attack Previous coronary angioplasty/stent Previous coronary artery bypass surgery/valve/pacemaker Overweight (BMI more than 30 – weight/height2 [kg/m2 ]) Renal impairment (Creatinine > 150 µmol/L) Contrast allergy/reaction

Contra-indications to Cardiac CT 1. Atrial fibrillation, bigeminy, trigeminy, high-grade heart block. 2. Frequent atrial or ventricular ectopic beats. 3. Unable to hold breath or lie still for ~ 15-20 seconds. 4. Inability to control heart rate to less than 80 BPM (discuss first). 5. Renal impairment (Creatinine > 200 µmol/L – please discuss). 6. Anaphylactic reaction to contrast. 7. Morbid obesity (Please discuss if patient is over 150 kg). 8. (Atrial fibrillation is not a contra-indication if patient is undergoing scan for

preparation prior to EP ablation procedure or biventricular pacemaker).

Patient preparation for Cardiac CT Patients may need beta-blockers – routine target heart rate of < 60 BPM. Routine dose: Metoprolol 50mg PO 12 hours and 1 hour prior to exam. Verapamil 80 mg may be used for severe asthma, COPD. Patients note the following: • Usual food/fluids and routine medications for 4 hours prior. • No heavy or regular exercise 24 hours pre-study. • No Cialis, Viagra, or Levitra for 36 hours pre-study. • No caffeine containing products for 12 hours pre-study. • Omit Metformin for diabetics on the day of the procedure. • Arrive early and in a calm and relaxed manner. • The slower and more regular the heart beat, the better the images.

CARDIAC CT SCANNER The new 64-slice CT scanner at MIA Radiology, Peninsula Private Hospital enables detection of heart disease prior to the onset of symptoms. Through powerful X-rays and software analysis, the scan can quickly establish the extent of coronary artery disease. This process is very quick and relatively non-invasive, and enables you to determine your risk of heart disease. CORONARY ARTERY DISEASE (CAD) AND RISK FACTORS

Individuals with certain risk factors are at increased risk of coronary artery disease. These include hypertension, high total cholesterol or low HDL (bad) cholesterol, diabetes, family history of premature heart disease, and smoking. If you have one or more of these risk factors, you may be at risk. Coronary artery disease (CAD) involves progressive build-up

of cholesterol plaques (atherosclerosis) that restrict flow of blood to the heart muscle. This process may be punctuated by sudden rupture of the plaque, resulting in clot formation and a heart attack. Not infrequently this process is silent, leading to sudden death. Damage to heart muscle is often irreversible, resulting in breathing difficulties, tiredness and lack of physical stamina as well as reduced lifespan. EVALUATION OF CORONARY ARTERY DISEASE Various methods are used to determine the presence of CAD. A treadmill stress test can infer presence or absence of CAD, but can be inaccurate. A stress nuclear scan may be used to check for possible blockages. Diagnostic coronary angiography involves advancing a catheter through the groin artery to the heart and injecting contrast dye to check for blockages. This process involves sedation, local anaesthetic, and a day’s stay in hospital.

CT CORONARY ANGIOGRAPHY A 64-slice CT scanner is a new diagnostic imaging tool that enables cardiologists to “see” blockages inside coronary arteries as well as the arterial wall (where plaques reside) and heart muscle damage. Other areas including heart valves, congenital heart abnormalities, coronary artery bypass grafts and stents can also be assessed. The CT scan also allows determination of heart function as well. A preliminary Calcium Score is performed – quantification of calcium (by-product of cholesterol deposits) is a surrogate marker of disease burden and an individual’s risk of a future heart attack. THE CARDIAC CT PROCEDURE Cardiac CT scanning is relatively simple and straightforward. Come in a calm and relaxed manner; the slower and regular the heartbeat, the better the images. Take usual medications and drink clear fluids. A medication to slow the heart rate may be given, and an IV drip is inserted into the arm. You will be asked to hold your breath for about 15 seconds while the contrast dye is injected and the scan is performed. The whole procedure usually takes 1 hour and you can resume your usual activities almost immediately. Review of the pictures is organised with your doctor or Dr. Szto. WHO MAY BENEFIT FROM A CARDIAC CT SCAN? Anyone who: • Experienced chest pains and/or shortness of breath. • Has equivocal or inconclusive treadmill stress test. • Have one or more risk factors that increase the likelihood

of premature heart disease, i.e. hypertension, diabetes, high cholesterol, smoking, or family history of premature coronary artery disease (heart attack, sudden death).

• Had prior stent or bypass surgery (check for patency). • Has suspected congenital heart disease or anomalies. • Want to check whether there has been progression of

CAD identified previously. DR. GREG SZTO AND CARDIAC CT Dr. Szto has interpreted and reported over 1,000 cardiac CT scans since Feb 2007. He is a member of the (US) Society of Cardiovascular Computed Tomography, and can guide individuals in identifying their risk of heart disease, and how to treat abnormalities. Dr. Szto is fully trained in diagnostic coronary angiography & stenting; and other heart, carotid and kidney stenting procedures. CT scanning is performed in partnership with MIA Radiology at Peninsula Private Hospital. The Cardiac CT scan will be reported by Dr. Szto and/or radiologist Dr. Andrew Watson. Cardiac CT scanning is currently not reimbursed by Medicare or private health insurance funds. An out-of-pocket fee applies.