Case Studies

Click on a hypothetical patient below to explore their scenario.

These patient profiles represent hypothetical patients. Images do not depict actual patients.

Dave

Dave

Dave is a 65-year-old man who experiences chest tightness when he walks upstairs but notices no symptoms at rest. He takes medication for diabetes and hypertension. He has a history of mitral valve prolapse and esophageal stricture. Last year, he had a hip replacement.

Examination

Vital Signs

  • Height: 5'9"
  • Weight: 245 lb
  • Blood pressure: 146/98 mm Hg
  • Heart rate: 60 bpm
  • Total cholesterol: 300 mg/dL
  • High-density lipoprotein (HDL): 50 mg/dL

 

Electrocardiogram (ECG)

  • Right bundle-branch block (RBBB), ST-T wave abnormalities at rest, and ST changes on stress

Estimated Risk

  • 10-Year atherosclerotic cardiovascular disease (ASCVD) risk: 40.9%2,a

aLifetime risk estimate only provided for individuals aged 20-59 years.

Assessment: Symptomatic, High Risk

The appropriate use criteria (AUC) rating of stress radionuclide imaging (RNI) for symptomatic patients with a high pretest probability risk of CAD is: APPROPRIATE.3

PET Test Results: Abnormal

Dave's positron emission tomography (PET) test showed a reversible defect in the anterior and apical walls in the left anterior descending artery. A coronary angiogram showed total occlusion of the left anterior descending artery.
Dave was scheduled for coronary revascularization.

Dave

Patrice

Patrice is a 55-year-old woman with a family history of CAD. She is obese and takes medication for hypertension, but says she never experiences chest pain or dyspnea. She used to be a heavy smoker, but says she now smokes just 1 pack a week.

Examination

Vital Signs

  • Height: 5'6"
  • Weight: 232 lb
  • Blood pressure: 141/95 mm Hg
  • Heart rate: 85 bpm
  • Total cholesterol: 240 mg/dL
  • HDL: 40 mg/dL

 

Electrocardiogram

  • ST-segment abnormalities

Estimated Risk

  • 10-Year ASCVD risk: 20.5%
  • Lifetime ASCVD risk: 50%2

Assessment: Asymptomatic, High Risk

The AUC rating of stress RNI for asymptomatic patients with a high risk of a cardiac event is: MAY BE APPROPRIATE.3

SPECT Test Results: Normal

Because of her family history of CAD, hypertension, and obesity, Patrice was referred for a single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) test. Results showed no inducible ischemia or perfusion abnormality.

However, due to her high risk for a CAD event, Patrice was prescribed statin therapy and advised to make lifestyle modifications.

Dave

Antonio

Antonio is a 47-year-old man with slight stress-related chest pain. For the past 3 years, he has been taking medication to control his hypertension. He is moderately physically active and says he eats a lot of red meat.

Examination

Vital Signs

  • Height: 5'11"
  • Weight: 220 lb
  • Blood pressure: 124/82 mm Hg
  • Heart rate: 65 bpm
  • Total cholesterol: 202 mg/dL
  • HDL: 56 mg/dL

 

Electrocardiogram

  • ST-segment abnormalities

Estimated Risk

  • 10-Year ASCVD risk: 2.5%
  • Lifetime ASCVD risk: 50%2

Assessment: Symptomatic, Low Risk

The AUC rating of stress RNI for symptomatic patients with a low risk of CAD is: RARELY APPROPRIATE.3

No Further Testing

Because Antonio is at low risk for CAD and a nuclear stress test would not have been appropriate for him, he was advised to make lifestyle modifications.

Dave

Jill

Jill is a 50-year-old woman scheduled for abdominal aortic aneurysm surgery. She is not experiencing any chest pain. However, she is sedentary and gets winded after climbing 2 flights of stairs. She is also a former smoker with diabetes.

Examination

Vital Signs

  • Height: 5'8"
  • Weight: 175 lb
  • Blood pressure: 135/80 mm Hg
  • Heart rate: 82 bpm
  • Total cholesterol: 205 mg/dL
  • HDL: 36 mg/dL

 

Heart

  • Regular rate and rhythm, no murmur

Electrocardiogram

  • Some baseline abnormalities

Estimated Risk

  • 10-Year ASCVD risk: 12.8%
  • Lifetime ASCVD risk: 50%2

Assessment: Poor Functional Capacity Prior to Vascular Surgery

The AUC rating of echocardiogram (echo) for a patient with poor functional capacity prior to vascular surgery is: APPROPRIATE.3

Echo Results: Abnormal

Jill's stress echo test results showed an ejection fraction of 30% and right ventricular systolic pressure of 63 mm Hg. Minor mitral regurgitation was detected, so she was sent for stress RNI prior to her surgery.