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Ultrafast computed tomography (CT) of the heart of a 46
year old man who presented with atypical chest pain revealed an increased calcium score of 1226, and showed severe calcification of the left main stem (LMS), the proximal left anterior descending (LAD) and the first diagonal (D1) arteries, suggesting the presence of significant underlying atherosclerosis. Subsequent coronary angiography revealed significant stenoses of the LMS, LAD, left circumflex, and D1 arteries. The patient underwent coronary artery bypass grafting and is now symptomatically well. Calcium is a component of the atherosclerotic plaque, and measurement of total coronary calcium score by ultrafast CT is a highly sensitive indicator of underlying atherosclerotic plaque burden. Ultrafast CT may be an appropriate first investigation in patients with atypical cardiac symptoms, in whom the pretest likelihood for ischaemic disease is considered low by the clinician.