Thanks all for the comments.
Keep in mind that the Cardiac Calcium score, EKG, or even a heart ultrasound won’t definitively show a blockage but may lead you to further testing. Also, a score of zero doesn’t rule out a blockage either!
If you have family history of high cholesterol, bypass surgery, heart attacks, etc you may find that your genetics are involved.
I have a genetic predisposition to high cholesterol, as my practitioner tested me for Lipoprotein (a) also written as Lp(a). This basically means that diet and exercise won’t change your high cholesterol numbers. Foot stomp here—if your Costco Red Rice Yeast and all your supplements aren’t helping you this may be the culprit.
Normal cardiac medicine would go along a prescribed path which steps up the degree of how invasive a procedure is, and your health insurance company will be a major factor in that pathway.
Here’s the thing—if your cardiac score exceeds a certain FAA number there is only one test they allow to start the process for special issuance and that’s a catherization, which your insurance company will blow a gasket over (procedure is about $80K amd you need two of them). I had to battle both the company and the insurance company to get this approved. If your score is less than 100 but more than zero you may be able to get away with a stress test but that wasn’t me.
Anyway, pilots tend to put off certain doctor stuff in fear of losing their medical—but had my situation become a heart attack, the survival rate on that particular artery would be about 11%.
To sum it up—my age, family history, Lp(a) factor, Cholesterol levels led me to the Calcium Score test. I had NO symptoms. If your score is more than zero you probably need to talk to your AME.
Here’s a good article from AMAS that talks about specifics
on this topic.