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Omar Alshuwaykh, Sarwan Kumar
(Department of Internal Medicine, North Bay Medical Center, Fairfield, CA, USA)
Med Sci Case Rep 2018; 5:31-32
Cardiac stress testing is a cornerstone in the diagnosis of myocardial ischemia. Patients presenting with chest pain who have intermediate pre-test probability and positive test results usually proceed to left heart catheterization, while those with negative test results are considered to have non-cardiac chest pain.
CASE REPORT: A 54-year-old man with a history of tobacco smoking, hyperlipidemia and a family history of early CHD presented with episodes of left-side chest pain for 3 weeks prior to admission. The episodes lasted about 20 min, pain was 6/10 in severity, pressure in nature, radiated to the left jaw and left arm, were aggravated by exertion and partially relieved by sublingual nitroglycerine, and sometimes were associated with palpitations and SOB. He had a negative dobutamine SPECT rMPI stress test 3 years ago for similar pain. EKG showed no evidence of ischemia; 3 sets of troponins were <0.010. A dobutamine SPECT rMPI stress test done before discharge was normal, showing no evidence of ischemia. His pre-test probability for CAD was intermediate. The patient insisted on cardiac catheterization because of his family history of early CHD and was found to have a diffuse 50% stenosis in the left circumflex coronary, severe 80% stenosis at the proximal part of the LAD, and total occlusion at the proximal part of the RCA. The patient underwent CABG of 3 vessels.
CONCLUSIONS: Physicians should be vigilant in interpreting stress tests results, especially when the stress test result is negative and the patient has intermediate pre-test probability.