A man in his late 60s with hyperlipidemia was referred for stress echocardiography for dyspnea on exertion. He exercised for 10 minutes on a standard Bruce protocol, reaching a peak heart rate that was 108% of his age-predicted maximum, attaining a workload of 11 metabolic equivalent tasks and Duke treadmill score of 10. The test was stopped for fatigue. His preexercise echocardiogram demonstrated a left ventricular ejection fraction of 65% with no regional wall motion abnormalities. After exercise, the ventricle became smaller and more vigorous and there were no wall motion abnormalities. At the urging of a family member, he sought a second opinion and underwent coronary computed tomography angiography (CCTA) at another institution, which demonstrated multivessel coronary artery disease (CAD). He then underwent coronary catheterization followed by 3-vessel coronary artery bypass graft (CABG) surgery. His immediate postoperative course was uncomplicated, and he was discharged on postoperative day 5.
Schmidt T, Maag R, Foy AJ. Overdiagnosis of Coronary Artery Disease Detected by Coronary Computed Tomography Angiography: A Teachable Moment . JAMA Intern Med. 2016;176(12):1747–1748. doi:10.1001/jamainternmed.2016.6660
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