Computed Tomography, Coronary Angiography, and Intravascular Ultrasound in the Diagnosis of Left Anterior Descending Stenosis in a 38-Year-Old Woman with a Calcium Score of Zero

TL;DR

A 38-year-old woman with no calcium buildup in her arteries showed signs of heart disease through imaging tests, leading to a careful diagnosis and conservative treatment.

Contribution

Highlights the diagnostic challenge of coronary artery disease in young women with a zero calcium score using multimodal imaging.

Findings

CCTA showed significant narrowing in the left anterior descending artery despite a zero calcium score.

Coronary angiography and IVUS revealed borderline narrowing, leading to conservative treatment.

The case emphasizes the limitations of calcium scoring in young women with atypical presentations.

Abstract

Cardiovascular diseases, including coronary artery disease, are the leading cause of mortality in the general population. The likelihood of significant coronary artery disease occurring in young women (<40 years of age) is very low. Diagnosis is challenging and often delayed, treatment tends to be suboptimal, and the long-term prognosis is poor. We present the case of a 38-year-old woman with typical anginal chest pain whose coronary computed tomography angiography (CCTA) revealed significant narrowing in the left anterior descending artery (LAD) despite a coronary artery calcium score (CACS) of zero. To assess the significance of the lesion, coronary angiography and intravascular ultrasound (IVUS) were performed, which revealed borderline narrowing. Conservative treatment was recommended.

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