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Teachable Moment
Less Is More
December 2016

Overdiagnosis of Coronary Artery Disease Detected by Coronary Computed Tomography Angiography: A Teachable Moment

Author Affiliations
  • 1Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
  • 2Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
JAMA Intern Med. 2016;176(12):1747-1748. doi:10.1001/jamainternmed.2016.6660

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.

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