Differential Diagnosis for Coronary Artery Disease
Single Most Likely Diagnosis
- Atherosclerotic Coronary Artery Disease: This is the most likely diagnosis given the presence of mild to moderate calcified plaque in all three territories with minimal 2 miles stenosis throughout the coronary system. The description is classic for atherosclerotic disease, which is the most common cause of coronary artery disease.
Other Likely Diagnoses
- Coronary Artery Spasm: Although less likely than atherosclerotic disease, coronary artery spasm could potentially cause stenosis, especially if it occurs at the origin of the first obtuse marginal. However, the presence of calcified plaque suggests a more chronic process.
- Inflammatory Coronary Artery Disease: Conditions like Kawasaki disease or other inflammatory processes could affect the coronary arteries, but they are less common and typically have other associated symptoms or findings.
Do Not Miss Diagnoses
- Acute Coronary Syndrome: Although the description suggests chronic disease, it's crucial not to miss an acute coronary syndrome (ACS), such as a myocardial infarction, which could present with similar findings but requires immediate intervention. The presence of more advanced disease at the origin of the first obtuse marginal could be a culprit lesion for ACS.
- Coronary Artery Dissection: A spontaneous coronary artery dissection could present with sudden onset of symptoms and might show minimal stenosis on imaging but is a medical emergency.
Rare Diagnoses
- Congenital Coronary Artery Anomalies: These are rare conditions that could affect the coronary arteries, potentially causing stenosis or other abnormalities. However, they are less likely given the description of calcified plaque, which suggests an acquired process.
- Coronary Artery Disease due to Other Systemic Diseases: Certain systemic diseases, such as mucopolysaccharidosis or other rare genetic disorders, can affect the coronary arteries. These are rare and would typically have other associated findings or symptoms.