Published in:
01-08-2016 | Images that Teach
Medical therapy for the treatment of myocardial ischemia
Published in: Journal of Nuclear Cardiology | Issue 4/2016
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A 67-year-old man presented with exertional chest pain for 1 month, which was retrosternal in location, non-radiating, and relieved at rest. He has diabetes mellitus, hypertension, and hyperlipidemia. The physical examination was normal. He was referred for exercise myocardial perfusion imaging (MPI). He exercised for 6 minutes on the Bruce protocol. The test was stopped because of shortness of breath. The rest and exercise ECGs were normal. The exercise and rest SPECT images showed a large reversible perfusion abnormality involving 40% of the LV myocardium in the distribution of the left anterior descending artery (LAD) (Figure 1, first panel).The LV ejection fraction was preserved at 69%. The CT coronary angiogram showed a non-calcified plaque with 75% stenosis in the proximal segment of LAD (Figure 2).
Figure 1
Baseline and follow-up exercise (Ex)/Rest (R) SPECT Tc-99m sestamibi MPI. (A) Stress images obtained at baseline (1st row) and after optimal medical therapy for IHD (2nd row) and at rest (3rd row). A large perfusion defect consistent with ischemia in the distribution of the left anterior descending artery is seen in the baseline MPI that is largely resolved after intensive medical therapy. (B) The extent of the perfusion defect on polar maps is large on the first study involving 40% of left ventricular myocardium (left panel) and decreases to 9% after intensive medical therapy (right panel). The left ventricular ejection fraction was preserved at 69% by gated SPECT in both studies
Figure 2
A non-calcified eccentric plaque resulting in luminal narrowing of more than 75% of the proximal LAD is seen (red circle) on non-invasive CT coronary angiography
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