What is coronary artery calcification. How is it detected and diagnosed. Who should get a calcium score CT. What are the benefits of cardiac CT compared to other imaging tests. How can a second opinion help patients diagnosed with coronary artery calcification. What questions should patients ask their second opinion radiologist.

Understanding Coronary Artery Calcification

Coronary artery calcification is a significant health concern that affects many individuals worldwide. It occurs when calcium builds up within the walls of the arteries that supply oxygen-rich blood to the heart. This calcium accumulation causes the arterial walls to harden, a condition known as atherosclerosis. In some cases, it can lead to narrowing of the coronary artery, potentially limiting blood flow to the heart muscle.

The importance of understanding coronary artery calcification cannot be overstated. It serves as a crucial biomarker for heart health and plays a vital role in determining an individual’s risk for heart disease. By detecting and measuring coronary artery calcification, healthcare professionals can better evaluate a patient’s cardiovascular health and recommend appropriate interventions.

Detection and Diagnosis of Coronary Artery Calcification

Coronary artery calcification can be detected through various imaging techniques. These include:

• X-ray
• CT scan
• MRI

However, the most effective and commonly used method for measuring coronary artery calcification is a specialized CT scan called Coronary Artery Calcium Scoring CT. This non-invasive procedure provides a detailed view of the coronary arteries and quantifies the amount of calcium present.

During the Calcium Scoring CT, patients are required to lie still and hold their breath for up to 30 seconds. The scan generates a coronary artery calcium score, which estimates the patient’s risk of experiencing a heart attack or stroke within the next 5-10 years.

Who Should Consider a Calcium Score CT?

Calcium Score CT is primarily recommended as a screening test for individuals at medium risk of heart disease. This includes people with:

• A personal history of high cholesterol
• Diabetes
• Hypertension
• Obesity
• A family history of coronary artery disease

It’s important to note that this test is not beneficial for individuals who have already experienced a heart attack, have a stent, or have undergone a heart bypass procedure. These patients are already considered high-risk and require different management strategies.

Benefits of Cardiac CT Compared to Other Imaging Tests

Cardiac CT, specifically the Coronary Calcium Score CT, offers several advantages over other imaging modalities:

1. Non-invasive: Unlike procedures that require catheter insertion or dye injection, cardiac CT is completely non-invasive.
2. Fast and painless: The scan is quick and causes no discomfort to the patient.
3. Detailed information: It provides comprehensive data about cardiovascular risk, allowing for more informed treatment decisions.
4. Early detection: Cardiac CT can identify calcification before symptoms appear, enabling early intervention.

These benefits make cardiac CT an invaluable tool in assessing and managing coronary artery health.

The Role of Second Opinions in Coronary Artery Calcification Diagnosis

Seeking a second opinion can be highly beneficial for patients diagnosed with coronary artery calcification. Dr. Giovanni Lorenz, a Cardiothoracic radiologist, emphasizes the importance of this practice:

“Coronary artery calcification is an important biomarker, but post-processing can be challenging. Second opinions can help ensure that the results are appropriately processed and interpreted. Additionally, the exam provides more than just a number – there are other anatomic and incidental extra-cardiac findings that are crucial in a comprehensive evaluation.”

A second opinion can offer:

• Confirmation of the initial diagnosis
• Alternative interpretations of the scan results
• Additional insights into incidental findings
• A more comprehensive understanding of the patient’s overall cardiovascular health

Key Questions to Ask Your Second Opinion Radiologist

When seeking a second opinion, it’s crucial to ask the right questions. Dr. Lorenz suggests the following:

1. What do the raw and normalized numbers mean in relation to the other anatomic findings in my coronary arteries?
2. How does the quantification relate to the anatomic exam and decision-making about medication?
3. Are there any incidental extra-cardiac findings that require attention?
4. What do the findings suggest about my overall cardiovascular health?

By asking these questions, patients can gain a more comprehensive understanding of their condition and the implications for their health.

Challenges in Accurately Scoring Coronary Artery Calcification

While Coronary Artery Calcium Scoring CT is a powerful diagnostic tool, it does come with certain challenges. Dr. Aimee Carswell highlights some of these issues:

• Patient movement: If a patient is unable to remain still or hold their breath as instructed, parts of the artery may be missed or scanned twice, leading to an invalid score.
• Elevated heart rate: A high heart rate can cause similar problems with scan accuracy.
• Patient size: Obesity may prevent a patient from fitting comfortably in the scanner, potentially affecting the quality of the images.

These challenges underscore the importance of proper patient preparation and the need for experienced radiologists to interpret the results accurately.

Overcoming Challenges in Calcium Scoring

To address these challenges and ensure accurate scoring, several strategies can be employed:

1. Patient education: Providing clear instructions on breathing techniques and the importance of remaining still during the scan.
2. Heart rate control: In some cases, medication may be used to lower the heart rate before the scan.
3. Advanced scanning techniques: Using newer CT scanners with larger gantry openings to accommodate patients of varying sizes.
4. Expert interpretation: Relying on experienced cardiothoracic radiologists to analyze and interpret the results, taking into account any technical limitations.

Implications of Coronary Artery Calcification for Cardiovascular Health

The presence of coronary artery calcification has significant implications for an individual’s cardiovascular health. It serves as an indicator of atherosclerosis and can predict future cardiovascular events. However, it’s essential to understand that the calcium score is just one piece of the puzzle in assessing overall heart health.

A high calcium score does not necessarily mean an immediate risk of heart attack or stroke. Instead, it suggests an increased risk over time and may indicate the need for more aggressive preventive measures or further diagnostic testing.

Risk Stratification Based on Calcium Scores

Calcium scores are typically categorized as follows:

• 0: No identifiable plaque, very low risk of cardiovascular event
• 1-10: Minimal plaque, low risk
• 11-100: Mild plaque, moderate risk
• 101-400: Moderate plaque, increased risk
• Over 400: Extensive plaque, high risk

These scores help physicians determine appropriate treatment strategies and lifestyle modifications for their patients.

Treatment Approaches for Coronary Artery Calcification

While it’s not possible to reverse coronary artery calcification, various treatment approaches can help manage the condition and reduce the risk of cardiovascular events:

1. Lifestyle modifications:
   • Adopting a heart-healthy diet
   • Regular exercise
   • Smoking cessation
   • Stress management
2. Medication:
   • Statins to lower cholesterol levels
   • Blood pressure medications
   • Aspirin therapy
3. Close monitoring:
   • Regular check-ups with a cardiologist
   • Periodic follow-up scans to track progression
4. Advanced interventions:
   • In severe cases, procedures such as angioplasty or bypass surgery may be necessary

The specific treatment plan will depend on the individual’s overall health, calcium score, and other risk factors.

Emerging Therapies for Coronary Artery Calcification

Research into new treatments for coronary artery calcification is ongoing. Some promising areas of study include:

• Targeted nanoparticle therapies to dissolve calcium deposits
• Gene therapies to prevent or slow calcification
• Novel drug combinations to stabilize existing plaques

While these treatments are still in the experimental stage, they offer hope for more effective management of coronary artery calcification in the future.

The Role of Prevention in Coronary Artery Health

Prevention plays a crucial role in maintaining coronary artery health and reducing the risk of calcification. Key preventive measures include:

1. Regular exercise:
   • Aim for at least 150 minutes of moderate-intensity aerobic activity per week
   • Include strength training exercises twice a week
2. Healthy diet:
   • Focus on fruits, vegetables, whole grains, and lean proteins
   • Limit saturated fats, trans fats, and added sugars
   • Reduce sodium intake
3. Stress management:
   • Practice relaxation techniques such as meditation or deep breathing
   • Engage in hobbies and activities that bring joy and reduce stress
4. Regular health screenings:
   • Monitor blood pressure, cholesterol levels, and blood sugar
   • Discuss risk factors with your healthcare provider

By adopting these preventive measures, individuals can significantly reduce their risk of developing coronary artery calcification and improve their overall cardiovascular health.

The Impact of Genetics on Coronary Artery Calcification

While lifestyle factors play a significant role in coronary artery health, genetic predisposition also contributes to the development of calcification. Recent studies have identified several genetic markers associated with an increased risk of coronary artery calcification.

Understanding one’s genetic risk can help in tailoring prevention strategies and treatment approaches. Genetic testing may be recommended for individuals with a strong family history of heart disease or those who develop coronary artery calcification at a young age.

The Future of Coronary Artery Calcification Diagnosis and Treatment

As medical technology advances, the future of coronary artery calcification diagnosis and treatment looks promising. Some exciting developments on the horizon include:

• Artificial intelligence-assisted image analysis for more accurate and efficient calcium scoring
• Advanced imaging techniques that can differentiate between stable and unstable plaques
• Personalized medicine approaches based on genetic profiles and biomarkers
• Minimally invasive treatments to remove or stabilize calcified plaques

These advancements have the potential to revolutionize how we detect, monitor, and treat coronary artery calcification, ultimately leading to better outcomes for patients.

The Role of Patient Education in Managing Coronary Artery Calcification

Empowering patients with knowledge about coronary artery calcification is crucial for effective management of the condition. Healthcare providers play a vital role in educating patients about:

1. The significance of their calcium score
2. The importance of adherence to treatment plans
3. The benefits of lifestyle modifications
4. The need for regular follow-up and monitoring

By fostering a partnership between healthcare providers and patients, we can improve compliance with treatment regimens and ultimately reduce the risk of cardiovascular events.

Integrating Coronary Artery Calcification Management into Overall Heart Health

Managing coronary artery calcification should be viewed as part of a comprehensive approach to heart health. This integrated approach includes:

• Regular cardiovascular risk assessments
• Comprehensive lipid profile monitoring
• Assessment of other risk factors such as diabetes and hypertension
• Consideration of overall vascular health, including peripheral artery disease

By taking a holistic view of cardiovascular health, healthcare providers can develop more effective strategies to prevent and manage coronary artery calcification.

The Psychological Impact of a Coronary Artery Calcification Diagnosis

Receiving a diagnosis of coronary artery calcification can be emotionally challenging for patients. It’s important to address the psychological aspects of the condition, which may include:

1. Anxiety about future health outcomes
2. Stress related to lifestyle changes
3. Depression associated with chronic health conditions
4. Fear of medical procedures or interventions

Providing psychological support and resources can help patients cope with their diagnosis and improve their overall quality of life. This may include referrals to mental health professionals, support groups, or stress management programs.

Significance of Coronary Artery Calcification on CT Scan

Checking for coronary artery calcification (build-up of calcium in the heart’s arteries) is one of the best ways to determine heart health.

It allows doctors to evaluate an individual’s risk for heart disease and can help prompt at-risk patients to make necessary lifestyle changes in order to prevent complications.

Coronary artery calcification can be seen and measured with heart imaging tests, like a CT scan. But understanding the results of such tests can be confusing. To help patients navigate the significance of coronary artery calcification on a CT scan, we spoke with two expert Cardiothoracic radiologists. Here, Dr. Giovanni Lorenz shares how patients who have been diagnosed with coronary artery calcification can benefit from getting a second opinion, followed by a deep dive with Dr. Aimee Carswell as she explains
how coronary artery calcification is scored, what it means to have a blockage, and more.

DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging scan from one of our chest & cardiac subspecialists, you can learn more here.

Benefits of a Second Opinion

How can a second opinion help patients who have been diagnosed with coronary artery calcification?

[Dr. Lorenz] Coronary artery calcification is an important bio marker (among family history, serological evaluation). However post processing can be difficult and so second opinions can be helpful to ensure they’re appropriately processed. Additionally, the exam is more than just a number – there are other anatomic and incidental extra cardiac findings that are important in your evaluation.

What questions should patients ask their second opinion radiologist?

[Dr. Lorenz] As a Cardiothoracic radiologist I know that numbers are one thing, and that patients should always ensure they understand the role of quantification in their anatomic exam and making decisions about medication. Patients should ask what the raw, normalized numbers mean and how that relates to the other anatomic findings in their coronary arteries. Also, patients should ask about incidental extra cardiac findings. Most exams cover the heart, lungs, esophagus and upper abdomen-which is an anatomic hotspot for many patients-lung nodules, reflux, etc.

Understanding Your Coronary Artery Calcification CT Scan

[DocPanel] What is coronary artery calcification?

[Dr. Carswell]

Coronary artery calcification is calcium buildup within the walls of the arteries that supply oxygen-rich blood to the heart. This calcium causes the walls to become more hardened, as seen with atherosclerosis. It may also cause narrowing of the inside of the coronary artery, which can limit blood flow to the heart muscle.

[DocPanel] How is coronary artery calcification detected and diagnosed?

[Dr. Carswell]

Coronary artery calcification may be seen on many different types of radiology exams, including x-ray, CT, and MRI. There is a special CT scan called a Coronary Artery Calcium Scoring CT that is used to measure the amount of calcium, giving a patient their coronary artery calcium score. That score is able to estimate the patient’s risk of having a heart attack or stroke in the next 5-10 years.

[DocPanel] Who should get a calcium score CT?

[Dr. Carswell]

A calcium score CT is a screening test. It helps your doctor know how to treat you if you have no symptoms. It’s recommended for patients at medium risk – including those with a personal history of high cholesterol, diabetes, hypertension, obesity, or a family history of coronary artery disease.

If you have already had a heart attack, have a stent, or have had a heart bypass procedure, you are already at high risk – so a calcium score CT would not be beneficial for these types of patients.

[DocPanel] Are there any challenges in accurately scoring coronary artery calcification?

[Dr. Carswell]

As with any CT scan, you must follow directions in terms of holding still and holding your breath for up to 30 seconds. If you are unable to properly follow the directions, part of the artery may be missed or part may be scanned twice, causing the score to be invalid. If your heart rate is too high, this may cause a similar problem. Additionally, if a patient is obese, they may not fit in the scanner.

[DocPanel] What are the benefits of cardiac CT when compared to other imaging tests?

[Dr. Carswell]

Coronary calcium score CTs are fast, painless, and easy but non-invasive ways to give your doctor more information about how to treat you. It is called “noninvasive” because you are not having to go to an operating room or fluoroscopy suite and have dye injected or catheters placed into your veins or arteries.

In terms of providing information about cardiovascular risk, coronary artery calcium scores are most beneficial for women who are 35-70 years old, and men who are 40-60 years old.

[DocPanel] What is considered a high calcium score?

[Dr. Carswell]

A negative test means there is no calcium. A positive test means there is calcium present, and it is graded as shown in the table below.

[DocPanel] What does it mean to have a high calcium score with no blockage?

[Dr. Carswell]

You may have a high calcium score, but if you had dye injected into your coronary arteries, either during a coronary artery CT scan (which differs from a non-contrast coronary calcium score CT) or during coronary angiography procedure under fluoroscopy, there may be no blockage in the arteries or no significant blockage.

This is due to a phenomenon called “positive remodeling” in which the calcium is found on the outer part of the vessel and “grows” outward instead of inward. At any rate, if you are in the age categories listed above and you have a high calcium score, you are at risk for a cardiovascular event. Additionally, some young patients may have no coronary artery calcium, but still have a blockage in the arteries, sometimes due to soft plaque. Soft plaque is atherosclerosis that does not contain calcium. This is why it is important for the referring providers to take other cardiovascular risk factors into account, in addition to the calcium score.

[DocPanel] What other markers are used to determine heart health?

[Dr. Carswell]

Other markers used to determine heart health include high blood cholesterol levels, family history of heart disease, diabetes, high blood pressure, smoking, obesity, and physical inactivity.

[DocPanel] What advice do you have for someone with a high calcium score?

[Dr. Carswell]

If your calcium score is high, you should discuss this with your doctor. They may give you recommendations on lifestyle changes, such as shifting to your diet, stopping smoking, or beginning an exercise program. They may also decide to place you on medications to help with other diseases, such as diabetes, high blood pressure, or high cholesterol.

Coronary Calcification – CVG Cares : CVG Cares

Coronary artery calcification is a buildup of calcium in your heart’s two main arteries, known as the coronary arteries. This is a continuation of the process called atherosclerosis, in which plaque composed of fat and cholesterol forms in the arteries over time, usually about 5 years. Coronary calcification can be an early indicator of coronary artery disease.

Intimal coronary artery calcification occurs in the inner artery layer, while medial coronary calcification is in the middle artery layer. The amount of calcification in your body determines how intense your atherosclerosis may be. The main issue caused by coronary calcification is the heart muscle’s inability to pump enough blood. This is due to the plaque creating a narrower pathway for the blood to flow through, so it becomes difficult for oxygen-rich blood to reach your heart.

Risk Factors For Coronary Calcification

There are many factors that can lead to increased risk of coronary calcification, such as chronic kidney disease, glucose issues, high cholesterol levels, high BMI, high blood pressure, and family history of coronary calcification. Other factors include older age, tobacco use, parathyroid hormone irregularities, and high phosphate or calcium levels.

Women who have gone through menopause and men are more likely to develop this disease, along with caucasians as opposed to other races.

Causes Of Coronary Calcification

As you age, calcium from your bloodstream can begin to settle in other parts of your body. Arteries that are damaged, inflamed, or have undergone repairs are more likely to attract calcium deposits. These deposits start small and increase in size over time as more builds up, with the process sometimes starting as early as in your twenties. According to researchers, the reason calcification begins is due to smooth muscle cells in the intimal layer dying.

If your arteries begin calcifying early, it may go unnoticed for several years as younger people do not usually have reasons to get imaging, and if you do happen to get imaging, the amount of calcium at this point may be so small that it is unable to be seen.

Symptoms Of Coronary Calcification

Coronary artery calcification often has no apparent symptoms in the beginning, but as more calcium builds up people may begin to experience symptoms such as chest pain, shortness of breath, numbness in your hands or feet, a decrease in blood pressure, and even heart attacks.

Testing For Coronary Calcification

There are a variety of tests your doctor may order to determine whether you have coronary artery calcification. Your doctor will begin with a physical exam and blood test while reviewing your personal and family medical history. Once this has been done, your doctor may conduct a coronary calcium score test, which is a screening test that uses a low radiation CT scan to find plaque in the coronary arteries. The higher the calcium score, the likelier you are to have coronary calcification.

Other tests your doctor may use include a coronary CT angiogram, which is a non-invasive test to measure your blood flow, as well as electrocardiograms, echocardiograms, and stress tests. More invasive tests to check the progression of the disease exist as well, such as a cardiac intravascular ultrasound, which is where your doctor will place an ultrasound wand at the end of a catheter to see the inside of your coronary arteries, allowing them to determine what stage of disease you are at.

Treatment For Coronary Calcification

To combat this disease, your doctor may recommend lifestyle changes, medications, or in severe cases, surgery. Lifestyle changes that can either prevent or slow the progression of coronary calcification include a healthy diet, increased physical activity, avoiding alcohol and tobacco, and losing weight. Your doctor may prescribe medications such as cholesterol medication, beta blockers, ACE inhibitors, diuretics, and medicine to prevent or dissolve blood clots.

In late stages of coronary calcification, your doctor may suggest surgical procedures to fight the disease. These include intravascular lithotripsy, in which a catheter is attached to a device that, when inserted, sends pressure waves designed to break up the calcification. After this, a stent is inserted to keep your arteries open.

Other surgical procedures that may be done include a rotational, orbital, or laser atherectomy in order to cut out the plaque and calcium from your artery. Bypass surgeries and angioplasties may also be recommended to treat the disease.

Complications Of Treatment

Medications that treat coronary calcification may have adverse side effects, and surgical procedures can sometimes lead to unfortunate complications, such as arrhythmias, aneurysms, bleeding, artery dissection, stroke, heart attacks, and even death.

How CVG Can Help

CVG offers a variety of services that can check and treat symptoms of coronary artery calcification. At CVG, we perform stress tests that will observe blood flow and test for Atrial Fibrillation. There are three types of stress tests that we perform:

A treadmill test is a test in which you will walk on a treadmill that gets faster and steeper every 3 minutes. This will stress your heart so that our nurse or doctor can determine your EKG and blood pressure.
An echo test is performed before and after your treadmill test to determine how well your heart pumps blood.
A nuclear stress test is a treadmill test that is prefaced by an injection of medicine that shows the flow of blood to your heart.

We also offer cardiac catheterization, in which a catheter is inserted into the heart in order to take pictures and conduct tests. This procedure allows doctors to gain more information about your condition and suggest treatment options.

If these tests determine a problem, we offer treatment solutions to fix several conditions. Learn more about our services here, or schedule an appointment to talk to our doctors.

Clinical and laboratory markers of calcific atherosclerosis | Drygina

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Calciphylaxis. What is Calciphylaxis?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Calciphylaxis is a rare, potentially life-threatening syndrome characterized by increased tissue sensitivity to calcium. The development of calciphylaxis reactions leads to rapid progression of calcification, thrombosis of small and medium-sized arteries, ischemia of the skin and subcutaneous tissue, and internal organs. The areas of tissues covered by the pathological process are sharply painful, gradually necrotic and ulcerate. Diagnosis includes performing x-rays of the affected areas, histological examination. Conservative treatment involves the correction of mineral metabolism, surgical – excision of affected areas within healthy tissues.

ICD-10

E83.5 Disorders of calcium metabolism

• Causes of calciphylaxis
• Pathogenesis
• Symptoms of calciphylaxis
• Complications
• Diagnostics
• Treatment of calciphylaxis
• Prognosis and prevention
• Prices for treatment

General

The term “calciphylaxis” was introduced by the Canadian researcher Hans Selye, who created an experimental model of calciphylaxis reactions in animals. In the English-language literature, the term “calcifying uremic arteriopathy” is used to define the disease. The syndrome is diagnosed mainly in patients of the older age group with end-stage renal failure. The incidence of pathology among patients on dialysis is, according to various sources, from 1 to 4%. 64% of them die in the first year after the onset of clinical signs of pathology from sepsis or rapidly progressive multiple organ failure.

Calciphylaxis

Causes of calciphylaxis

The role of calciphylaxis reactions in dermatology has not been studied enough. In his works, G. Selye considered calcium sensitization as a protective reaction, during which the deposition of lime can increase the resistance of tissues to the effects of damaging factors. A combination of several reasons leads to the development of the pathological process:

• Severe kidney damage. The disease develops in dialysis patients and in patients undergoing kidney transplantation. It is based on a violation of the metabolism of mineral salts in the body, primarily calcium and phosphorus, which is aggravated by the use of dialysis media with calcium salts in the composition.
• Secondary hyperparathyroidism. Violation of the function of the parathyroid glands against the background of renal failure is observed quite often. A change in the concentration of parathyroid hormone disrupts the balance of bone and extra-osseous calcium and phosphate metabolism, accelerates bone resorption, promotes the release of minerals into the blood, and stimulates the deposition of salts in the walls of blood vessels.

Increases the likelihood of formation of calciphylaxis reactions diabetes mellitus, obesity, the use of glucocorticosteroids, immunosuppressants, anticoagulants such as warfarin, polyneuropathy, endocrine diseases, monoclonal gammopathy. The more risk factors a patient has, the faster the disease progresses, the more difficult the treatment and the worse the prognosis.

Pathogenesis

The development of the pathological process is based on two phenomena: sensitization to calcium and the effect of so-called “permitting” factors that provoke the deposition of calcium salt in the vascular wall. A local increase in the concentration of minerals in the intima of the vessels leads to a change in the phenotype of the cells of the vascular wall. Smooth muscle cells gradually degenerate into bone tissue cells. Arteries lose their elasticity, their lumen narrows. Arterial stenosis progresses rather slowly. At this stage, there are no external manifestations of the disease or they are insignificant.

The development of acute painful ischemic purpura is associated with thrombosis. The appearance of blood clots contributes to the slowing of blood flow in stenotic arterioles, damage to the inner lining of blood vessels, hypercoagulability. Progressive circulatory disorders cause tissue ischemia and subsequent necrosis.

Symptoms of calciphylaxis

The pathological process mainly captures the posterior and lateral surfaces of the legs, buttocks, abdomen, forearms and hands, in men – the penis. The skin in the affected area turns pale, becomes much denser to the touch, sometimes acquires a marbled hue. The foci are sharply painful. Intense pain can make it difficult for the patient to move. If the calves are affected, the patients cannot walk, they are forced to move around in a wheelchair. Opioid analgesics may be needed to control pain. With diabetic polyneuropathy, pain may be absent.

Gradually deficient in oxygen and nutrients, tissues die off with the formation of ulcers. An intermediate stage in the formation of an ulcer is a bubble with a flaccid tire, filled with serous contents mixed with blood. When the bubble bursts, the eroded surface is exposed. Ulcers are deep, penetrating into the subcutaneous tissue. A scab is forming along the edges of the skin wound. The skin around the ulcer gradually changes color from marbled white to dark red, cyanotic or purple. Necrosis is characterized by a black color of the skin. The affected area is steadily expanding and can capture entire anatomical regions. The process progresses over several weeks or months.

A rather rare variant of the course of calciphylaxis is the involvement of internal organs in the pathological process, in particular, the terminal sections of the large intestine. With this form of the disease, foci of ischemia form in the abdominal cavity, which is accompanied by the appearance of intense pain in the abdomen, bleeding from the intestines.

Complications

The main complications of calcific arteriopathy are sepsis, progressive multiple organ failure, and tissue necrosis requiring necrectomy. In the absence of medical care, gangrene of the fingers and penis can result in their spontaneous amputation. In 1-2% of cases, due to damage to the coronary arteries, cardiac arrest occurs. In the intestinal form of the pathology, bleeding from the gastrointestinal tract forces doctors to perform abdominal operations one after another, remove necrotic sections of the intestine, and restore intestinal patency. Taking into account the patient’s end-stage renal failure and other severe comorbidity, the outcome of large-scale surgical interventions is not always favorable.

Diagnostics

It is difficult for a dermatologist to make a diagnosis of calciphylaxis. Often doctors of other specialties are involved in the diagnosis: a surgeon, a nephrologist, an oncologist, an endocrinologist. At the initial stages, the disease in its manifestations resembles a number of other pathological processes, therefore it is necessary to conduct several different diagnostic tests and evaluate their results in the aggregate:

• X-ray examination. X-rays of the legs, chest and abdomen are taken. Vessels with lime deposits are clearly visible on radiographs. In the chest cavity, calcification of the aorta is detected, in the abdominal cavity – mesenteric vessels, arteries that feed the liver and other organs with blood. In controversial or unclear cases, computed tomography is performed.
• Kidney biopsy. In samples of kidney tissue taken for histological examination, nephroangiosclerosis and calcification are detected. Lime deposits are located mainly in the middle layer of the vascular wall. The study is used for early diagnosis of pathology, clarification of the condition of the kidneys. Histological examination of the skin is not informative, since the changes in it are nonspecific.
• Determination of calcium (Ca) and phosphorus (P) levels. Serum concentrations of Ca and phosphate are used to assess the risk of soft tissue, vascular, and renal calcification in an established diagnosis. Calciphylaxis crisis can develop with a low product of Ca and P concentrations. High values ​​are not always a sign of calciphylaxis.
• Study of the level of parathyroid hormone. Calcium metabolism in the body is regulated by parathyroid hormones. The development of pathology is usually associated with secondary hyperparathyroidism, which develops in patients with renal insufficiency. But a decrease in the function of the parathyroid glands can also adversely affect mineral metabolism.

In dermatology, local manifestations of calciphylaxis must be differentiated from dystrophic and metastatic calcification of the skin, systemic scleroderma, the development of fulminant purpura in DIC, warfarin (heparin) necrosis, and some types of vasculitis. In surgery, differential diagnosis is carried out with putrefactive phlegmon, thromboembolism of large arteries.

Treatment of calciphylaxis

The effect of the therapy can be obtained only with an integrated approach. Medical tactics may vary depending on the patient’s condition, comorbidities, the rate of progression of ischemia. As a rule, the doctor has to take into account several serious diseases that the patient has at once, each of which can lead to rapid decompensation of the condition and death. The main treatments include:

• Correction of therapy for the underlying disease. Any drugs that provoke the deposition of lime are excluded: iron preparations, vitamin D, anticoagulants, corticosteroids, etc. If the drugs cannot be completely canceled, their dose is adjusted. The number of hemodialysis sessions increases from 3 to 5 per week. Changing the ionic composition of dialysis solutions in order to reduce the concentration of minerals in the blood.
• Treatment of wounds. To prevent the spread of pyogenic infection in the tissues, the area of ​​​​ulceration is treated with antiseptic solutions, ointments with antibiotics are applied. Dead fragments are removed surgically. Due to the high probability of penetration of bacteria into the blood with the development of sepsis, broad-spectrum antibiotics are preemptively prescribed.
• Subtotal resection of the parathyroid glands. The method is used in cases where the deposition of lime in the vessels is detected in the early stages of the formation of the pathological process, and according to the biochemical blood test, there is a sharp increase in parathyroid hormone in the blood. In the later stages of the disease, the benefit of surgery is usually minimal.
• Physiotherapy. Hyperbaric oxygenation procedures, which are prescribed in repeated courses, allow accelerating the healing of ulcers. A good effect can be obtained from oxygen cocktails. An increase in oxygen concentration in tissues maintains cell viability, stimulates the healing process, which increases the effectiveness of conservative and surgical treatment.
• Administration of bisphosphonates. It is an experimental method. The main property of bisphosphonates is to prevent the loss of minerals by bone tissue. The less calcium is washed out of the bone, the lower its concentration in the blood serum. There are reports of the effective use of one of the drugs of the pamidronic acid group for the treatment of calciphylaxis in patients suffering from severe renal insufficiency.
• Symptomatic treatment. Appointed individually in each case. May include weight loss in obesity, control and correction of blood sugar levels in diabetes mellitus, the appointment of tissue plasminogen activator in patients with thrombosis of the veins of the lower extremities, sodium thiosulfate to reduce calcium in the blood, infusion therapy to eliminate intoxication resulting from tissue breakdown.

Prognosis and prevention

It is impossible to eliminate the cause of the development of calciphylaxis, but it is possible to balance the mineral metabolism in such a way as to prevent the loss of salt crystals from the blood and at the same time not provoke osteoporosis in patients suffering from impaired renal function. The prognosis and survival of patients is higher in cases of early detection of pathological changes in the vessels before the development of clinical symptoms (ischemia and ulceration), the compensated state of patients for other diseases they have (diabetes mellitus, arterial hypertension, etc.). Methods for the prevention of calciphylaxis have not been developed. It is recommended to seek medical help in a timely manner, take the medicines prescribed by the doctor, undergo the necessary examinations and procedures.

You can share your medical history, what helped you in the treatment of calciphylaxis.

References

1. Monckeberg’s calciphylaxis with necrosis of the glans penis: A case presentation/ Mathew D.