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A CT Coronaryangiogram was ordered. Here are the results: --Minimally obstructive coronary artery disease. --LAD Although a lesion is not visible anatomically on this CT scan, coronary catheter angiography could be considered based on Cardiology evaluation." A repeat troponin returned at 0.45 CAD-RADS category 1. --No
Past medical history includes coronarystenting 17 years prior. If you take old people with a history of MI (he had a stent), that percentage goes far higher since there is scar tissue that acts as a nidus for the PVCs that initiate VT. Episodes of angina over past couple of months had been progressive.
This was texted to me from a former resident, while working at a small rural hospital, with the statement: "I can’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS." I said that this is unstable angina until proven otherwise. Thus, Unstable Angina. Troponins negative."
The scan also showed “scattered coronary artery plaques”. __ Smith comment 1 : the appropriate management at this point is to lower the blood pressure (lower afterload, which increases myocardial oxygen demand). If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia.
Diamond and Forrester accomplished this by first establishing the prevalence of coronary artery disease based on how clinically likely patients with chest pain symptoms were found to have coronary disease based on a coronaryangiogram. The results of this dataset by age and gender follow.
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