In this month’s PulsePoints case with Ambreen Mohamed, MD, FACC, a 52-year-old man came in with three weeks of chest pressure during exertion that was worse when climbing stairs, but relieved with rest.

He had multiple risk factors, but no prior cardiac diagnosis, and wasn’t on a statin. His ECG and troponin were normal, yet his symptoms pointed to an intermediate likelihood of coronary artery disease.

Instead of a traditional stress test, we chose Coronary CT Angiography (CTA) to look directly at plaque, not just infer ischemia. Results showed a 60–70% narrowing in the proximal LAD with high-risk plaque features, plus additional non-obstructive disease. FFR confirmed a significant lesion, and he underwent PCI with a drug-eluting stent.

With guideline-directed therapy, including a high-intensity statin, aspirin, and a P2Y12 inhibitor, his symptoms resolved and his functional capacity improved.

The bigger takeaway is that Coronary Disease often develops silently, long before a major event, and there is a real opportunity to detect it earlier and prevent it altogether.

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