Case 7 A 39-year-old woman with a history of hypertension, chronic renal failure (creatinine = 3.1), and remote cocaine abuse was admitted for evaluation of nonexertional dull chest pain. She had a normal coronary angiogram 4 years previously for similar symptoms. Initial Diagnostic Evaluation Laboratory data: troponin T = 0.375 ng/mL (normal < 0.040), CK = 38 U/L ECG: NSR, LVH with nonspecific ST-T abnormalities Echocardiogram: moderate concentric LVH, no regional wall-motion abnormalities, EF = 50% Referred for adenosine stress 99mTc sestamibi SPECT MPI 5-Minute adenosine infusion without supplemental low-level treadmill exercise, peak HR = 91 beats/min, normal BP response Baseline ECG The baseline ECG demonstrates increased QRS voltage consistent with left ventricular hypertrophy (LVH), with nonspecific ST-T abnormalities possibly related to LVH. 4:50 Adenosine (Mild Chest Pain) The patient complained of mild chest pain near the completion of the adenosine infusion. The ECG tracing obtained at 4 minutes, 50 seconds of the adenosine infusion demonstrated more prominent ST-T abnormalities with T-wave inversions suspicious for (but not diagnostic for) myocardial ischemia. This finding is common in patients with baseline LVH. 5:50 Recovery (Persistent Chest Pain) The patient described persistent chest pain nearly 6 minutes after completion of the adenosine infusion. This is highly unusual; the side effects of adenosine are typically very short-lived, owing to the very short half-life of adenosine (<10 seconds). An ECG tracing was obtained and demonstrated persistent nonspecific ST-T abnormalities. 9:00 Recovery (Worsening Chest Pain) 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 18 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 7 Full access? Get Clinical Tree
Case 7 A 39-year-old woman with a history of hypertension, chronic renal failure (creatinine = 3.1), and remote cocaine abuse was admitted for evaluation of nonexertional dull chest pain. She had a normal coronary angiogram 4 years previously for similar symptoms. Initial Diagnostic Evaluation Laboratory data: troponin T = 0.375 ng/mL (normal < 0.040), CK = 38 U/L ECG: NSR, LVH with nonspecific ST-T abnormalities Echocardiogram: moderate concentric LVH, no regional wall-motion abnormalities, EF = 50% Referred for adenosine stress 99mTc sestamibi SPECT MPI 5-Minute adenosine infusion without supplemental low-level treadmill exercise, peak HR = 91 beats/min, normal BP response Baseline ECG The baseline ECG demonstrates increased QRS voltage consistent with left ventricular hypertrophy (LVH), with nonspecific ST-T abnormalities possibly related to LVH. 4:50 Adenosine (Mild Chest Pain) The patient complained of mild chest pain near the completion of the adenosine infusion. The ECG tracing obtained at 4 minutes, 50 seconds of the adenosine infusion demonstrated more prominent ST-T abnormalities with T-wave inversions suspicious for (but not diagnostic for) myocardial ischemia. This finding is common in patients with baseline LVH. 5:50 Recovery (Persistent Chest Pain) The patient described persistent chest pain nearly 6 minutes after completion of the adenosine infusion. This is highly unusual; the side effects of adenosine are typically very short-lived, owing to the very short half-life of adenosine (<10 seconds). An ECG tracing was obtained and demonstrated persistent nonspecific ST-T abnormalities. 9:00 Recovery (Worsening Chest Pain) 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 18 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 7 Full access? Get Clinical Tree
