Coronary Calcium Score (CAC)

This is a low-dose CT scan that measures calcium in the heart (coronary) arteries. It detects the calcium within plaques, which reflects the amount of long-term plaque buildup and artery hardening (atherosclerosis).

It’s most useful for people over 40 with risk factors and a moderate level of heart risk (as calculated by QRISK3), when it isn’t clear if starting cholesterol tablets (statins) would help lower risk or not.

It is not useful for people at very low risk or already at high risk, and it should not be repeated if you are on a statin because statins may actually increase calcium scores because they make plaques more stable (by facilitating plaque calcification).

The test takes about 15 minutes at a radiology clinic, is not covered by Medicare, and costs about $400. It is usually a one-time test, but can be repeated after four years if you are still not on a statin.

Stress Echocardiogram (Stress Echo)

This test looks at how your heart works when it is under stress, usually while running on a treadmill or cycling. It can detect poor blood flow to the heart (ischaemia).

It is not a screening test, but is used to establish whether the heart is involved if you have symptoms such as chest pain, shortness of breath, unexplained tiredness, or palpitations.

It is done in cardiology clinics, costs about $500, and most of the cost is covered by Medicare if you meet the eligibility criteria.

Coronary CT Angiography (CTCA)

This scan shows both hardened (calcified) and soft cholesterol plaques inside the heart arteries, which can cause narrowing and increase the risk of a heart attack.

It is more detailed than the calcium score and can pick up early disease. It is most useful in people with intermediate risk or unclear symptoms. The scan uses contrast dye, takes about 3 hours (the scan itself is around 15 minutes), and costs up to $800. Medicare rebates are available if a cardiologist or respiratory specialist refers you and certain conditions are met.

Coronary Angiogram

This is not a screening test. It is the most detailed way of looking at the heart arteries, showing exactly where the blockages are. It is usually recommended for people who are high-risk, have worrying symptoms, or if other tests (like stress echo or CTCA) suggest significant disease. It is always done by a cardiologist in a cardiac catheterisation laboratory associated with a hospital.