Cases from a busy nuclear cardiology laboratory

Excerpt

A 54-year-old woman with a history of hypertension and an active tobacco smoker was referred for nuclear stress testing to evaluate atypical chest pain of 6 months duration. Physical examination was normal with a heart rate of 82 beats per minute (bpm) and blood pressure of 131/64 mm Hg. Her baseline electrocardiogram (ECG) showed normal sinus rhythm without any ischemic changes. She noted the presence of chest pain after receiving regadenoson but this resolved spontaneously and did not require administration of a reversal agent. No ischemic changes were noted on ECG. The Single-Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging (MPI) with technetium-99m sestamibi (Figure 1) showed a large perfusion defect in the distribution of the left anterior descending artery involving more than half of left ventricular myocardium. There was complete reversibility in the perfusion defect from stress to rest. Transient ischemic dilation was present with a ratio of 1.30. The gated images showed a normal left ventricular ejection fraction (LVEF) of 62% at rest (Video 1, right panel) compared to an LVEF of 52% post stress due to myocardial stunning. Given the high-risk stress test findings, she was admitted to the hospital and underwent invasive coronary angiography which revealed a proximal focal severe stenosis in the left anterior descending artery (LAD, Figure 2, and Video 2). After undergoing percutaneous coronary intervention (PCI) with stent placement, she was discharged home on dual anti-platelet therapy. On follow-up, she noted her chest pain had resolved.

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