Case Presentation - American Society of Nuclear Cardiology …病例报告-美国核心脏病学会….pptVIP

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2018-06-30 发布于浙江
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Case Presentation - American Society of Nuclear Cardiology …病例报告-美国核心脏病学会….ppt

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Case Presentation - American Society of Nuclear Cardiology …病例报告-美国核心脏病学会…

Case of the Month Jenny Delfin MD and Ola Akinboboye MD MPH MBA FACC. Case Presentation The patient is a 51 year old male with a history of hypertension, DM (II), and hyperlipidemia who presented to our institution with the chief complaint of non-exertional chest pain. A 2 day stress-rest Tc-99m-sestamibi perfusion study was performed because of his size. Exercise stress testing was performed on a treadmill using the Bruce protocol. Case Presentation Approximately 40 mCi of Tc-99m sestamibi was injected at rest and during stress. Gated perfusion imaging was performed with attenuation correction using vantage software. Case Presentation The patient was able to perform 7 minutes of Bruce protocol. Exercise was interrupted because of breathlessness, generalized and leg fatigue. The patient had no chest discomfort during exercise and recovery. Case Presentation The maximum heart rate and blood pressure during exercise were 171 bpm (101% of the predicted maximum heart rate for age) and 194/70 mmHg respectively. The maximum workload attained was 9 METS. Cardiac exam was normal before and after exercise. Case Presentation The resting electrocardiogram revealed ST-T abnormalities. There was no electrocardiographic evidence of ischemia during exercise. The SPECT myocardial perfusion scan raw data showed good image quality with a normal sized left ventricle. Gated analysis did not reveal any significant wall motion abnormality. Perfusion Scans There was no significant perfusion abnormality on the uncorrected perfusion scans (fig 1). The corrected scans showed a medium-size reversible basal-anterior perfusion abnormality with moderate reduction in counts (fig 2). However, the quality control indices (fig 3) for the stress and rest studies showed critically low counts and the presence of truncation that was deemed to be non-critical. Case Presentation Because the patient has multiple risk factors including diabetes and an equivocal perfusion study, the re