Case 22 A 66-year-old male with hypertension, hyperlipidemia, and known coronary artery disease presented to the hospital with worsening angina over the last few weeks. He had suffered a myocardial infarction and underwent coronary artery bypass grafting in the past (1982 and 1992). He presented with angina in October 2004, and coronary angiography showed proximal complete occlusion of all three native vessels. Left internal mammary graft to the left anterior descending coronary artery was patent, but there was 70% narrowing distal to the left internal mammary artery touchdown. SVGs to the RCA and D1 were occluded. SVGs to the OM2 and OM3 had 95% occlusion. He underwent PCI and stenting of the SVGs to OM2 and OM3. During this admission, acute myocardial infarction was ruled out, but the patient was found to be severely anemic. His hemoglobin was 5.7 g/dL, white count was 5100/μL, with a differential of N-49%, L-31%, M-17%, E-2%, Blasts-1%, and a platelet count of 93,000/μL. He was transfused with multiple units of blood, and his hemoglobin increased to 10 g/dL. He was scheduled to undergo upper and lower gastrointestinal endoscopy to look for any possible sources of blood loss. He had no evidence of hemolytic anemia. He was referred for pharmacologic stress perfusion imaging for cardiac evaluation prior to the endoscopy procedures. He underwent 2-day rest/stress perfusion imaging using 25 mCi of 99mTc-sestamibi on each day. With 5-minute adenosine infusion, his heart rate changed from 57 to 66 beats/min, and blood pressure changed from 168/83 to 155/84 mm Hg. He complained of chest tightness during adenosine infusion. His electrocardiogram showed normal sinus rhythm with intraventricular conduction delay and nonspecific ST-T changes. There was further 1-mm ST depression during adenosine infusion. (Video 1a) (Video 1b) (Fig. 1a) (Fig. 1b) (Fig. 1c) (Video 2a) (Video 2b) Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Cardiac Neurotransmission Imaging: Single-Photon Emission Computed Tomography 6 Myocardial Perfusion Imaging with Contrast Echocardiography Digital/Fast SPECT: Systems and Software Stay updated, free articles. Join our Telegram channel Join Tags: Clinical Nuclear Cardiology State of the Art and Future Direction Jun 11, 2016 | Posted by admin in CARDIOLOGY | Comments Off on 22 Full access? Get Clinical Tree
Case 22 A 66-year-old male with hypertension, hyperlipidemia, and known coronary artery disease presented to the hospital with worsening angina over the last few weeks. He had suffered a myocardial infarction and underwent coronary artery bypass grafting in the past (1982 and 1992). He presented with angina in October 2004, and coronary angiography showed proximal complete occlusion of all three native vessels. Left internal mammary graft to the left anterior descending coronary artery was patent, but there was 70% narrowing distal to the left internal mammary artery touchdown. SVGs to the RCA and D1 were occluded. SVGs to the OM2 and OM3 had 95% occlusion. He underwent PCI and stenting of the SVGs to OM2 and OM3. During this admission, acute myocardial infarction was ruled out, but the patient was found to be severely anemic. His hemoglobin was 5.7 g/dL, white count was 5100/μL, with a differential of N-49%, L-31%, M-17%, E-2%, Blasts-1%, and a platelet count of 93,000/μL. He was transfused with multiple units of blood, and his hemoglobin increased to 10 g/dL. He was scheduled to undergo upper and lower gastrointestinal endoscopy to look for any possible sources of blood loss. He had no evidence of hemolytic anemia. He was referred for pharmacologic stress perfusion imaging for cardiac evaluation prior to the endoscopy procedures. He underwent 2-day rest/stress perfusion imaging using 25 mCi of 99mTc-sestamibi on each day. With 5-minute adenosine infusion, his heart rate changed from 57 to 66 beats/min, and blood pressure changed from 168/83 to 155/84 mm Hg. He complained of chest tightness during adenosine infusion. His electrocardiogram showed normal sinus rhythm with intraventricular conduction delay and nonspecific ST-T changes. There was further 1-mm ST depression during adenosine infusion. (Video 1a) (Video 1b) (Fig. 1a) (Fig. 1b) (Fig. 1c) (Video 2a) (Video 2b) Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Cardiac Neurotransmission Imaging: Single-Photon Emission Computed Tomography 6 Myocardial Perfusion Imaging with Contrast Echocardiography Digital/Fast SPECT: Systems and Software Stay updated, free articles. Join our Telegram channel Join
