Test Appropriateness Index

We utterly agree with Stern,who designated diagnostic imaging as being “out of control.” A 65-year-old heavy smoker with chronic obstructive pulmonary disease,longstanding diabetes,hypertension,hypercholesterolemia,coronary artery disease,bilateral carotid stenosis,and intermittent claudication presented with acute dyspnea and palpitations. He had severe pulmonary congestion with rapid atrial fibrillation and blood pressure of 200/80 mm Hg,mandating intubation and ventilation. He was soon stabilized and extubated,his third similar episode over 2 months. Serum troponin was unchanged but was increased in the previous episodes. His last cardiac catheterization,6 weeks prior,showed a decreased ejection fraction (35%),chronically obstructed right coronary artery with collaterals,and nonobstructive left coronary arteries. In the Department of Medicine,he was presented to the consultant cardiologist,who saw him briefly and decided on another catheterization,which he would do himself for a special fee. Coronary angiography results were identical to the previous one,and no angioplasty was done.
The American Journal of Medicine

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