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A 48 year old black woman with
hypertension and chest pain.
Height: 5'5"; Weight: 194 lbs.
ECG Results:
- Normal Sinus Rhythm
- Nonspecific T-wave abnormality
- Otherwise normal ECG
- Ventricular Rate 64 bpm
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Pertinent Lab Values: A
cardiac injury panel was ordered:
| Test |
Test Result |
Range |
Units |
| CK, Total |
169 |
30-235 |
IU/L |
| CK-MB |
1.9 |
0.2-5 |
ng/ml |
| CK Relat.Index |
1.1 |
0-2.4 |
|
| Troponin I |
<0.1 |
0-1.4 |
ng/ml |
Nuclear Medicine: She was
referred to the nuclear medicine department for evaluation of possible
myocardial ischemia.
IV Persantine Stress. Under rest
conditions the patient was injected with 0.56 mg per kg of IV Persantine (47 mg total) over 4 minutes. The resting heart rate
was 59 beats per minute and blood pressure was 99/56. The EKG
demonstrated normal sinus rhythm without acute change. Following
Persantine infusion the heart rate measured 75 beats per minute and
blood pressure was 110/74. The patient reported no systemic
symptoms.
IMPRESSION: PHYSIOLOGIC RESPONSE
TO IV PERSANTINE WITHOUT ISCHEMIC CHANGE IDENTIFIED.
Myocardial Perfusion Study with SPECT.
At rest the patient received an IV injection of 11 mCi of Tc-99m
Sestamibi. SPECT images of the myocardium were obtained after a
1hour delay. Seven minutes into the Persantine infusion the
patient received an additional 32 mCi of Tc-99m Sestamibi and the
imaging sequence repeated.
Post stress images demonstrate a defect
in perfusion involving the anterior wall of the left ventricle.
IMPRESSION: REVERSIBLE DEFECT
INVOLVING THE ANTERIOR WALL OF THE LEFT VENTRICLE. THE FINDINGS
ARE CONSISTENT WITH A LAD DISTRIBUTION LESION.
Please click on
the image for enlargement and magnification.
Quantitative Gated SPECT.
Gated SPECT imaging was performed during stress acquisition. The
left ventricular end diastolic volume was calculated at 79 cc, the end
systolic volume at 32 cc, and the left ventricular ejection fraction
at 62 percent.
IMPRESSION: NORMAL QUANTITATIVE
GATED SPECT. THE REFERRING PHYSICIAN IN THE FAMILY MEDICINE
SERVICE WAS NOTIFIED OF THE RESULTS.
The patient left the hospital after the
procedure. Her physician called her at home and told her the
results of her positive stress test that morning and told her to go to
the ER. The patient said she was experiencing significant
exertional chest pain, but no nausea, diaphoresis, dizziness, or
dyspnea. The patient complained of chest pain with heart racing
and said she was not feeling well. She said she would go to the
ER tonight.
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© 2003 Nuclear Education
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Images courtesy of UAMS Dept of
Nuclear Medicine.
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