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Imaging Quiz Question

A New Cardiac Test for an Older Doctor

John D. Cantwell, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 6 - JUNE 98


A physically active 69-year-old male physician was seen after he had an electron beam computed tomography (EBCT) scan of his heart. The test was offered free to physicians.

The patient ran 2 miles three times a week, strength trained twice a week, and was active with his two teenage sons, playing basketball and camping. He denied any chest pain on initial questioning.

His medical history indicated mild-to-moderate hyperlipidemia, treated with a low-fat diet. He had been hospitalized once for diverticulitis. His only medication was one aspirin daily for preventive purposes. There was no history of cigarette smoking or alcohol abuse.

His father died of his first heart attack at age 68 and had had non-insulin-dependent diabetes. A 67-year-old brother has a history of hypertension and had coronary bypass surgery in his early 60s.

On physical examination, the patient's blood pressure was mildly elevated at 150/90 mm Hg, and his pulse was 62 per minute and regular. An intermittent midsystolic click was noted on initial auscultation.

Laboratory data showed a total cholesterol level of 229 mg/dL, triglyceride of 103 mg/dL, high-density lipoprotein of 68 mg/dL, and low-density lipoprotein (LDL) of 140 mg/dL. His resting electrocardiogram was normal. The EBCT scan is shown in figure 1.

[FIGURE 1]

What does the EBCT scan show? What would you do next?

Dr Cantwell is a cardiologist at Cardiology of Georgia, PC, and clinical professor of medicine at Morehouse School of Medicine, both in Atlanta. He is an editorial board member of The Physician and Sportsmedicine. Address correspondence to John D. Cantwell, MD, Cardiology of Georgia, PC, 95 Collier Rd NW, Suite 2075, Atlanta, GA 30309.


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