Case 1: A 42-year-old man, a mill worker, had been under a lot of stress due to problems in his family. He was experiencing chest pressure, which certainly suggested angina pectoris, and there were even some ECG changes during his stress test. However, his coronary angiogram was perfectly normal. As well, a special test was performed to see if he had any coronary spasm (a squeezing or narrowing that is sometimes induced during angiography). That was negative also. It was concluded that the chest pressure was a symptom of stress and not angina pectoris. The patient returned to work with peace of mind and was greatly relieved.
Case 2: A 62-year-old retired policeman had problems with indigestion, but also experienced chest pressure while exercising. This chest pressure eventually got worse, and he was admitted to hospital, where an angiogram showed a very significant narrowing of 80% to 90% in the right coronary artery. However, the arteries on the left side were in quite good shape. Based on this information, he was referred for coronary angioplasty (a procedure using a balloon-like device to open up the artery). This was performed successfully 2 days later, leaving no (0%) narrowing in the right artery.
Case 3: A 52-year-old diabetic woman who took insulin regularly was having chest pain even while at rest. Until the angiogram was done, there was a fear that the chest pain was indicative of severe blockage of the coronary arteries that might cause a heart attack. However, the coronary angiogram showed that, although the coronary arteries were quite narrowed and small everywhere, there was no major narrowing or blockage. Such a pattern is referred to as diffuse small-vessel disease.
Case 4: A 65-year-old woman with high cholesterol and high blood pressure was admitted to a hospital because she had chest pain even at rest, and her ECG showed changes while the chest pain was occurring. Her coronary angiogram showed a nearly complete (99%) blockage in the circumflex artery, and a very tight blockage (more than 95%) of the left anterior descending coronary artery. In addition, the right coronary artery showed a narrowing or blockage estimated at 80%. Since there was narrowing or blockages in each of the 3 major coronary arteries, it was recommended that she have coronary bypass surgery, which was carried out successfully.