# 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.

## Key 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.