Positive nuclear medicine cardiac stress test

Case contributed by Dr Jayanth Keshavamurthy


Elderly male with history of hypertension and dyslipidemia presents to ER with shortness of breath on exertion.

Patient Data

Age: 70 years
Gender: Male

Abnormal stress ECG showing ST-T wave depression in V2, V3, V4 andV5 leads concerning for coronary artery disease in circumflex coronary artery territory.

Nuclear medicine

Exercise stress test performed in supine and prone images. Rest images obtained in supine position.

First row -supine stress images.

Second row- rest images.

Third row-prone stress images.

Here we do the stress images first and then the rest images.

4 DM software was utilized for post-processing above.

Abnormal stress test is concerning for a large area of reversible perfusion deficit in the lateral wall with corresponding decreased wall thickening,

Emergent cardiac catheterization was performed the next morning.

Coronary artery catheterization is showing 2 vessel severe CAD and was referred to CABG.

Case Discussion

Based on the findings of ECG abnormalities during exercise stress nuclear test, chest discomfort relieved by nitroglycerin during the stress test, a large reversible perfusion deficit in the lateral and inferior wall, the patient was thought to have myocardial ischemia due to significant coronary artery disease in a left dominant circulation.

Cardiac catheterization confirmed 2-vessel disease and the patient was referred for CABG.

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