Instruction:
Jing is a 46-year-old male. He is an insurance executive who is married with two children. Jing is active in his church and plays golf on the weekends. He went to see his cardiologist because he experienced recent fatigue with chest pain on exertion. He has never smoked but he consumes 1 to 2 alcoholic drinks per day. His medical history reveals a blood cholesterol level of 260 mg%, a triglyceride level of 198 mg% and an HDL-C value of 43 mg%.    After studying a 12-lead ECG tracing of Jing's heart, it is clear that his heart is ischemic. Suggest some follow-up screening tests and recommended interventions.

Response:
There are lots of options for follow-up screening tests. For example, we can perform an echocardiogram with a color Doppler, where we can evaluate blood flow through the heart and create a picture of the heart and its moving valves. We can do a myocardial perfusion scan, which also evaluates blood flow in the heart. There’s also a procedure called electron-beam computed tomography (EBCT) which can detect calcium deposits in arteries. There’s also computed tomography angiography which reveals plaque or calcium deposits. We can perform a coronary MRI or MRA, which uses magnetic fields to detect valve problems, heart enlargement, vessel disease, damaged heart tissue, etc. Finally, we can also perform a coronary angiogram, which is invasive, but is the “gold standard” for diagnosing CAD. There are interventions available to Jing, which range from less invasive/intense to most intense. He can do daily things like reduce his high alcohol consumption, eat a heart-healthier and less inflammatory diet to help his cholesterol and triglyceride levels. There are also some medications to treat myocardial ischemia such as a daily aspirin, nitrates, beta blockers, cholesterol-lowering medications, etc. If his situation is very serious/deteriorates, he can consider angioplasty/stenting, or even coronary artery bypass surgery. These interventions are listed in order of least to most aggressive.