Prior inferolateral infarct on myocardial perfusion scan
Recent marked reduction in exercise tolerance. Known IHD with prior STEMI 10 years ago, treated with PCI and stenting. Angiography performed 2 years ago consistent with two-vessel CAD. EF 47% on echocardiogram with inferior and lateral wall motion abnormalities. Last year had sigmoid colectomy (CRC) followed by postop AF with RVR. Hypertension. On Bisoprolol and Isosorbide mononitrate.
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The patient received IV adenosine, 40.9mg over four minutes, with low level exercise.
One day rest/stress supine myocardial perfusion SPECT imaging with ECG gating and CTAC (Tc-99m sestamibi; 292 plus 1057MBq).
During the adenosine infusion, the patient performed leg swinging exercise and did not experience chest pain. The test was terminated due to end of protocol.
Heart rate was 65bpm at rest and 84bpm at maximum. Blood pressure was 140/70 at baseline and 150/80mmHg at recovery.
The resting 12-lead ECG showed normal sinus rhythm with atrial ectopics and Q-waves present in aVF. The stress ECG showed no ischemic ST-segment changes and frequent atrial premature beats.
The stress and rest myocardial perfusion images showed a severe fixed perfusion defect in the basal inferolateral wall of the left ventricle. No significant reversible defects were detected. There was no evidence of transient ischemic LV dilatation. On the post-stress images the area of the severe fixed defect appeared severely dyskinetic to akinetic. The estimated LVEF was normal.
On the low dose CT study, there is severe coronary artery calcification particularly of the LAD and RCA.
4DM-SPECT automated analysis:
- Fixed perfusion defect: 6%
- Reversible perfusion defect: 0%.
- Left ventricular ejection fraction: 61%.
- Severe fixed perfusion defect of the basal inferolateral wall of the left ventricle in keeping with prior myocardial infarction.
- No significant reversible myocardial ischemia.
- Normal resting left ventricular ejection fraction with regional wall motion abnormality as above.
Example of a MPS showing a prior MI.