Clinical History

This is a 58-year-old female with chest pain and dyspnea on exertion and her height is 5'7", and her weight is 354 pounds. Blood pressure 127/84, with heart rate 71. Patient says she has occasional chest pain which is atypical in nature and she does note increasing dyspnea on exertion over the last several months. Current medication: Zioc, Albuterol p.r.n. for asthma, Aspirin, and Glucosamine for Type II diabetes.

Technique

Adenosine stress was performed and her baseline EKG shows a normal sinus rhythm, rate was approximately 62. There is an occasional PVC. There is no ST, QRS or T-wave abnormalities. 132 mg of Adenosine was infused using a calibrated pump over six minutes. The patient complained of slight shortness of breath and dizziness, but no chest pain. Her shortness of breath resolved after 1 to 2 minutes. There were no wheezes to auscultation at that time. Blood pressure remained stable in the range of 120/70 with a steady heart rate and no ST wave changes during the stress portion. Again, an occasional PVC was noted. Conclusion for the stress EKG portion is no electrophysiologic changes during Adenosine test.

Tomographic images: Prior to the Adenosine stress test, a pre-injection cold transmission study was performed on the patient and she was not moved until the entire study was complete. At the end of three minutes, 26mCi of 13NH3 was injected with continuation of Adenosine for an additional three minutes. Emission imaging was performed, immediately thereafter, and attenuation correction was applied during reconstruction. At the end of the stress perfusion study, a resting perfusion study was performed with 40mCi of 13NH3.

Findings

There is marked photopenia in the entire apical third of the myocardium on the stress perfusion images with moderate to marked changes in the anterior septum. Moderate to marked changes are seen in the inferior septum. The rest of the myocardium shows good perfusion. The resting perfusion images show good perfusion throughout the myocardium except breast attenuation artifact in the basilar 2/3 of the anterior wall. There is also some attenuation artifact in the inferior septum.

Impression

THERE IS MARKED REVERSIBLE ISCHEMIA IN THE APICAL THIRD OF THE MYOCARDIUM EXTENDING INTO THE ANTERIOR SEPTUM. THERE ARE EQUIVOCAL CHANGES IN THE BASILAR THIRD OF THE INFERIOR SEPTUM WITH DEFINITE REVERSIBLE ISCHEMIA NOTED IN THE APICAL 2/3 OF THE INFERIOR SEPTUM. THE REST OF THE MYOCARDIUM IS NORMALLY PERFUSED. THERE IS TRANSIENT ISCHEMIC DILATATION OF THE LEFT VENTRICLE DURING STRESS. THERE IS MARKED REVERSIBLE ISCHEMIA IN THE APICAL THIRD OF THE MYOCARDIUM WITH MARKED REVERSIBLE ISCHEMIA IN THE ANTERIOR SEPTUM AND INFERIOR SEPTUM. THERE IS ALSO TRANSIENT ISCHEMIC DILATATION. THIS IS A HIGH-RISK SCAN.