A real case and a real question...

A 74 year old man is active and exercises daily. He has no symptoms. He is on statin for hyperlipidemia, and has no other risk factors. He has had + calcium scan in 2000 and again in 2008 and has had stress tests in 2002 and 2006 with normal imaging, but abnormal ECG (good exercise tolerance). His cardiologist at the time tells him to continue his medical therapy. A new cardiologist repeats the stress test and again finds discordant results with the echo normal, but the ECG abnormal. He decides to do an exercise nuclear perfusion scan and again the perfusion is normal, but the ECG is abnormal. So he sends him for a CTA. The CTA could not be done because the patient has "too much calcium in his arteries". What would you do next?


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