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Clinical Problems in Cardiopulmonary Disease |

Asymptomatic Coronary Artery Disease*: Choices in Evaluation

Allan Zelinger, MD; Roberto Wayhs, MD; Thomas B. Graboys, MD; Morton E. Tavel, MD, FCCP
Author and Funding Information

*From the Advocate Christ Medical Center (Dr. Zelinger), Oak Lawn, IL; and the University of Illinois at Chicago (Dr. Wayhs), Chicago, IL; Harvard Medical School (Dr. Graboys), Lown Cardiovascular Center, Brigham and Women’s Hospital, Boston, MA; and Editor of Clinical Problems in Cardiopulmonary Disease (Dr. Tavel).

Correspondence to: Allan Zelinger, MD, Assistant Clinical Professor of Medicine, Director, Echocardiography Laboratory, Advocate Christ Medical Center, 4400 W 95th St, Suite 407, Oak Lawn, IL 60453



Chest. 2002;121(5):1684-1687. doi:10.1378/chest.121.5.1684
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Extract

An asymptomatic 62-year-old man was referred for cardiologic evaluation as a result of an abnormal score on an electron beam CT (EBCT) scan of his heart together with an abnormal finding on a stress echocardiogram. He had a strong family history of cardiac disease. He was engaged in an active lifestyle, regularly exercising and playing racquet sports, and had given up smoking about 10 years previously. For 5 years, he had been treated with pravastatin therapy for an elevated cholesterol level. Nonetheless, his low-density lipoprotein (LDL) level consistently exceeded 100 mg/dL, and his high-density lipoprotein (HDL) level was < 45 mg/dL. The patient was normotensive and not diabetic or overweight. He had never experienced cardiac symptoms such as angina pectoris. Because of his concern about cardiovascular health, he requested and underwent an EBCT study, with the resultant score of 100 (calcium deposition within the coronary vasculature), which was said to demonstrate the probability of “moderate” coronary disease. His personal physician then ordered a stress echocardiogram, which indicated the likely presence of inferior wall ischemia, although the patient showed good effort tolerance (achieving a workload of 12 METs), experienced no symptoms, and demonstrated no ECG evidence of myocardial ischemia.

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