A 28 year old postpartum woman with right sided chest discomfort: case outcome

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Abstract
Discussion This case highlights the importance of ruling out coronary artery disease in patients such as Mrs Patel who have an intermediate risk of coronary artery disease. Exercise electrocardiography is the most widely used technique for the diagnosis and risk stratification of patients with suspected or known coronary artery disease. However, the exercise test is truly diagnostic in only 40% of patients.1 Stress echocardiography is a reliable and cost effective method for diagnosis and risk assessment of patients with suspected or known coronary artery disease. The hallmark of myocardial ischaemia during stress echocardiography is reduced systolic wall thickening, which precedes the occurrence of chest pain and ST-T changes. In patients with normal results on resting and exercise echocardiography, mortality has been shown to be less than 1% a year.2 3 This is the final part of a three part case report, which describes the outcome and summarises the comments made by readers during the case presentation. Further responses are welcome through bmj.com