Stress test is first choice the

Dear Dr. Roach: My primary care doctor prescribed a cardiac calcium test after seeing me breathing hard while climbing onto the examining table. I don’t feel a need for it, as I am over 72 years old and it is common in this age. I checked with another doctor and he asked what if you have higher cardiac calcium as I am already taking atorvastatin and enalapril.

Since then, I have been avoiding the test. What is your advice? — J.M.

Shortness of breath with exercise is indeed common, but when people have difficulty breathing with pretty minimal exertion, I would be concerned that there is a problem. Blockages in the blood vessels to the heart muscle — coronary artery disease — is one common and treatable cause of breathing problems with exertion, and high cholesterol and high blood pressure are risk factors for coronary artery disease. I think a test to determine whether you have CAD is reasonable.

However, the coronary calcium score wouldn’t be my first choice. A coronary calcium score looks for calcium deposits in the blood vessels to the heart, and high levels do make CAD more likely. Since a coronary calcium score doesn’t provide information about whether (and how big) those blockages might be, a stress test, would be my first choice, followed by a definitive anatomical test, like a coronary angiogram, if abnormal.

If there are blockages and you have symptoms despite medical therapy, your cardiologist would consider treating those blockages with a coronary stent. If the blockages were severe and in the left main coronary artery, cardiac surgery would be indicated.

The coronary calcium score is best used for higher-risk asymptomatic people, especially when trying to get more evidence to weigh the risks and benefits of medical treatment.