Wk 5, Case 1 - Review

Patient History
60-year-old man presents with increasing chest pain on exertion. Risk factors include hyperlipidemia and diabetes mellitus.

Findings
Coronary origins and proximal course are normal. The coronary arterial system is right dominant
There is severe (>70%) stenosis in the proximal Left anterior descending artery (LAD) caused by a segment of predominantly non calcified plaque. Furthermore there is positive remodeling indicative of a high risk plaque.

The left main coronary artery is normal.

Normal right coronary artery and posterior descending branch without calcification or non-calcified plaque.

The circumflex coronary artery and obtuse marginal branch are also normal without atherosclerotic disease.

Left and right ventricular size and cardiac morphology is normal. Normal atrial size Normal appearances of the pericardium.

Impressions
1. Severe proximal left anterior descending (LAD) coronary artery stenosis (70-99% stenosis) caused by non-calcified plaque with the high risk feature of positive remodeling.
2. CAD-RADS 4A.