The radiation dose diminished considerably. The reductions in the use of invasive coronary angiography and coronary revascularisation could not be explained by changes in patient characteristics but are driven by an increased use of perfusion scans in combination with increasing use of measurement of functional coronary flow reserve.

Chest pain in children and young people is a frequent cause of contact to general practitioners and outpatient clinics. However, in children, chest pain is typically benign and self-limiting; it is not usually a manifestation of organic disease, and it is very rarely of cardiac origin. The cause of chest pain often remains undiagnosed. There are a number of chronic conditions known to be associated with recurrent chest pain. Symptoms and signs include crushing left-sided precordial pain, pain radiating to the left arm or the jaw, pain onset with exercise and subsiding at rest (with asthma excluded), and an abnormal cardiovascular examination suggests referral for cardiac evaluation. We here report a case of stable angina pectoris in the young.

The lymphoscintigraphic pattern in the head and neck lymphatics was studied in 45 healthy subjects. After submucous injection of Lymphoscint-solco in the oral cavity there was visualization of regional lymph nodes immediately after food intake. There was an extreme variation in the number of visualized lymph nodes and a lack symmetry between right and left side of the neck. The accumulated radioactivity in subsequent lymph nodes showed an extreme variation. Accordingly no characteristics of diagnostic value could be evaluated from this study.

BackgroundIn ‘real-world’ patient populations undergoing coronary CT angiography (CCTA), it is unclear whether a correlation exists between gender, coronary artery calcium (CAC) score and subsequent referral for invasive coronary angiography and coronary revascularisation. We therefore investigated the relationship between gender, CAC and use of subsequent invasive coronary angiography and coronary revascularisation in a cohort of patients with chest discomfort and low to intermediate pretest probability of coronary artery disease who underwent a CCTA at our diagnostic centre.MethodsThis is a cohort study that included patients examined between 2010 and 2013. Data were obtained from the Western Denmark Heart Registry. The follow-up ended 11 March 2014.ResultsA total of 3541 people (1621 men and 1920 women) were examined by CCTA. The rate of invasive coronary angiography during follow-up was 28.5% in men versus 18.3% in women (p<0.001). The rate of coronary revascularisation during follow-up was 11.4% in men versus 5.1% in women (p<0.001). The CAC-adjusted HR in women versus men was 0.98 (95% CI 0.85 to 1.13) for invasive coronary angiography and 0.73 (95% CI 0.57 to 0.93) for coronary revascularisation. Further adjustment for age and other risk factors did not change these estimates.ConclusionsWomen had a lower CAC score than men and a corresponding lower rate of invasive coronary angiography. The risk of coronary revascularisation was modestly reduced in women, irrespective of CAC. This may reflect a gender-specific difference in coping with chest discomfort, gender-specific referral bias for CCTA, and/or a gender-specific difference in the balance between coronary calcification and obstructive coronary heart disease.

The 320-row CCTA might rule out CAD in low- to intermediate-risk patients. However, its accuracy in identifying patients who require revascularization is limited. The CACS added to the conventional risk factors did not improve the identification of patients who require revascularization.