ABSTRACT
The patient was treated medically for his angina with atenolol 50 mg daily and enteric coated aspirin, 325 mg daily. He was on no lipid-lowering therapy and simvastatin 40 mg a day was started. He did well for the next 3 years but again developed recurrent symptoms of exertional angina. A repeat myocardial perfusion stress test revealed worsening ischemia in the anterior wall and new ischemia in the inferior wall. In contrast to his previous stress test the ischemia this time developed at a low exercise workload. Cardiac catheterization now revealed severe disease in the saphenous vein graft to both marginal branches. He underwent repeat coronary artery bypass surgery, after which his angina was relieved.
