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of concern. The cardiology community knows that most 10. Fishbein MC, Siegel RJ. How big are coronary atherosclerotic
acute events and plaque ruptures occur because of non­ plaques that rupture? Circulation. 1996;94:2662–2666.
calcified plaque with a lesion of 30% to 70% in luminal
narrowing. 9,10

This case is part of a 15­patient pilot project intended Dr Singh is a practicing cardiologist in Jacksonville, Florida.
to determine if vulnerable plaques in vulnerable patients She earned her medical degree at the New York College of
Osteopathic Medicine and completed her residency in internal
are predictive of STEMI. Further studies in asymptom­ medicine at Lenox Hill Hospital. She recently completed her
atic patients with at least one risk factor are needed, fellowship in cardiology at Northside Hospital in St. Peters­
using plaque CCTA analysis in combination with serum burg, Florida.
biomarker testing to identify vulnerable plaques in vul­
nerable patients (PROTECT Registry). Dr Kroman is currently a third­year internal medicine resi­
dent at Northside Hospital in St. Petersburg and will continue
We hope that this case study brings light to the impor­ on with her cardiology fellowship at the same location.
tance of new noninvasive techniques for risk assessment,
which may lead to solving the problem of predicting Ms Singh is a third­year medical student at Ross University
acute coronary events in the future. School of Medicine. She received a bachelor’s degree in biol­
ogy from SUNY Stony Brook, State University of New York.
E­mail: JulieSingh@students.rossu.edu.
Disclaimer
Mr Tariq is a third­year medical student at Saba University.
This study commenced after being approved by the He received his bachelor’s degree in cellular molecular and mi­
United States Army Institute of Surgical Research Insti­ crobial biology and his master’s degree in medical science at
tutional Review Board. the University of Calgary in Canada.

Ms Amin is a second­year medical student at Meharry Medi­
Disclosures cal College in Nashville, Tennessee. She received bachelor’s
The authors have nothing to disclose and no conflicts of degrees in biology and psychology from the University of Flor­
interest to report. ida. E­mail: shetamin@gmail.com.

Dr Morales-Pablon is a practicing cardiologist in Tampa,
References Florida. He earned his medical degree at the University of
Saint Eustatius School of Medicine and completed his inter­
1. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease nal medicine residency at the Medical College of Georgia. He
and stroke statistics – 2009 update: a report from the American recently completed an advanced cardiac imaging fellowship at
Heart Association Statistics Committee and Stroke Statistics
Subcommittee. Circulation. 2009;119:480–486. the University of South Florida and has joined Dr Harrison at
2. Hadamitzky M, et al. Optimized prognostic score for coronary the Harrison Cardiovascular Center.
computed tomographic angiography: results from the CONFIRM
Registry. J Am Coll Cardiol. 2013;62:468–476. Ms Cahill is a practicing physician assistant at Harrison Car­
3. Chinnaiyan KM, et al. Coronary computed tomography angiog­ diovascular Center in Tampa, Florida. She received her bach­
raphy after stress testing. J Am Coll Cardiol. 2012;59:688–695. elor’s in food science and human nutrition at the University of
4. Pontone G, Andreini D. A long­term prognostic value of CT Florida, and her PA degree at Nova Southeastern University.
angiography and exercise ECG in patients with suspected
CAD. J Am Coll Cardiol Imaging. 2013;6:641–650. Dr Harrison received his medical degree from the University
5. Schlett CL, et al. How to assess non­calcified plaque in CT an­ of Kentucky and completed an internship, internal medicine
giography: delineation methods affect diagnostic accuracy of
low attenuation plaque by CT for lipid core plaque in histology. residency, and cardiology fellowship at the University of South
Eur Heart J. 2013;14:1099–1105. Florida, where he was a special fellow of the Florida Heart
6. Libby P. Mechanisms of acute coronary syndromes and their Association. He currently works in office practice in Tampa,
implications for therapy. N Engl J Med. 2013;368:2004–2013. Florida, while also serving as a preceptor for the University
7. Cross DS, et al. Coronary risk assessment among intermediate of South Florida Morsani School of Medicine and Saba Uni­
risk patients using a clinical and biomarker based algorithm de­ versity Medical School of the Netherlands Antilles. He is a
veloped in validated in two population cohorts. CMRO. 2012; member of the Special Operations Medical Association and
28:1819–1830. serves as a civilian consultant for the US Armed Forces as part
8. Levine GN, et al. 2011 ACCF/AHA/SCAI guideline for percuta­ of the 6th Medical Group at MacDill Air Force Base in Tampa,
neous coronary intervention. J Am Coll Cardiol. 2011;58:e44– Florida.
e122. doi:10.1016/j.jacc.2011.08.007.
9. Giroud D, Li JM, Urban P, et al. Relation of the site of acute
myocardial infarction to the most severe coronary arterial ste­
nosis at prior angiography. Am J Cardiol. 1992;69:729–732.

10 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015