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Health Minister’s heart surgery
THERE was a big question mark over Health Minister Khaw Boon Wan’s heart condition after he went for a calcium score test in March.
His calcium score of 507 was very high, indicating that there was plaque build-up in his arteries.
 It led to more tests and one of them showed an abnormal reading. It ultimately led to Mr Khaw going for bypass surgery last month.
Mr Khaw has since been discharged. After being on medical leave for six weeks, he went back to work on Monday this week.
An average of 800 patients a year undergo the calcium score test, which costs about $400 (before GST) at The National Heart Centre Singapore (NHCS).But what exactly is the calcium score, and who should check their calcium score?
What is the calcium score?
The calcium score indicates the amount of calcium in and around the coronary arteries.
Using the calcium score and other clinical findings, a patient’s risk of developing coronary heart disease and heart attacks can be better estimated.
How is it calculated?
A scan of the heart is taken by a CT scanner. The scan must be timed with the patient’s heart beat.
The images are processed on a work station and the exact calcium score is calculated from that.
0 - 10 – Minimal
11-100 – Moderate
101- 400 – Increased
Over 400 – Extensive
What does it indicate?
The presence of coronary calcium in the arteries indicates that the process of atherosclerosis (plaque build-up) has started.
The higher the calcium score, the more likely one will develop coronary artery disease or a heart attack.
Does a high score mean narrowing of arteries?
No. Other tests (such as a stress ECG, stress nuclear scan, CT angiogram or stress echocardiogram) may be needed to further define the disease, said Assistant Professor Tan Swee Yaw, consultant cardiologist at NHCS.
There is no screening test that can fully detect coronary artery disease, Assistant Prof Tan cautioned.
“Only after (getting a) detailed history of the patient’s symptoms
and risk factors and examining the patient, should a doctor decide on which is the most appropriate test for that particular situation,” he said.
Who is at risk?
Generally, patients who are older, who smoke, have high cholesterol, diabetes and hypertension are at higher risk of having atherosclerosis and a high calcium score.
Patients who have been determined to have an intermediate risk of developing coronary artery disease based on traditional risk factors such as cholesterol should have their calcium scores checked.
Previous studies have shown that people with calcium scores of above 400 have a higher risk of cardiac events. On the flip side, a calcium score of zero does not mean that there is no risk of coronary artery disease.
There are some forms of atherosclerosis that develop without the presence of coronary calcium and these “soft plaques” will not be detected by the calcium score scan.
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