Annals Consult Guys - Coronary Artery Calcium Score: Chalk or Cheese?
Authors: Geno J. Merli, Howard H. Weitz
Journal: Annals of Internal Medicine (2020)

Web Exclusives21 July 2020Annals Consult Guys - Coronary Artery Calcium Score: Chalk or Cheese?FREEGeno J. Merli, MD and Howard H. Weitz, MDGeno J. Merli, MDThomas Jefferson University, Philadelphia, Pennsylvania (G.J.M., H.H.W.)Search for more papers by this author and Howard H. Weitz, MDThomas Jefferson University, Philadelphia, Pennsylvania (G.J.M., H.H.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/W19-0040 CME/MOC SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Annals Consult Guys brings a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations. They address medically relevant topics—whether they be poignant, thought-provoking, or just plain entertaining.For more videos from and information on Annals Consult Guys, visit go.annals.org/ConsultGuys. Comments0 CommentsSign In to Submit A Comment Stephen Leenay, MD FACPPark Nicollet Clinic Executive Health and Compass Program22 July 2020 CAC in a 60 yo runner. It seems to me, the presence of a CAC score of 300 would indicate the (definite) presence of atherosclerosis, and the patient’s management becomes that of secondary prevention, though the initial discussion (prior to a CT scan/CAC/Heart Scan) was a management question for primary prevention. (The risk calculators discussed are all for primary prevention of ASCVD, not?) So; a high intensity statin, and ASA 81 mg daily, and better BP management, (<130/<80) by either adding a diuretic to the ACE, or considering a beta blocker. (The beta block may not be accepted well by the athlete, as it might hamper peak athletic performance.) As far as a stress test, a conversation with the patient and some shared decision making. No clear reason to do a test, but more careful questioning of potential symptoms with running. A comment was made that he has “slowed down.” So, did he slow down due to unexpected DOE? Perhaps he feels a little tight in the chest on a hill, and slows down in response? As functional as he is, a strong argument could be made for medical therapy alone. Nice case, and an excellent discussion review as usual. Disclosures: None Emelita C Co, MD FACPHumbold Park Health Care9 March 2021 CAC in endurance runner Nice real case we see in primary care. Thanks for the discussion. If I am his doctor I will put him on high intensity statin. I agree, I will do stress test on him bec it is well known that some people had " silent myocardial injury " because some peolple don't feel the classic chest pain . He seemed to have admitted he had slowed down, is it from dyspnea? from low myocardial perfusion sign? I will discussed with him about stress test and it will be a shared decision with the patient. Disclosures: no conflict of interest Author, Article, and Disclosure InformationAffiliations: Thomas Jefferson University, Philadelphia, Pennsylvania (G.J.M., H.H.W.)Disclosures: Geno J. Merli, MD, and Howard H. Weitz, MD, report that they have no financial relationships or interests to disclose.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he has no financial relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 21 July 2020Volume 173, Issue 2Page: CG1KeywordsCheesesCoronary artery calcificationDiagnostic techniquesDisclosure ePublished: 21 July 2020 Issue Published: 21 July 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.Loading ...