LEARN NUCLEAR MEDICINE
Cardiology · Case 02
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 45 year old woman comes into your clinic with atypical chest pain. Her risk factors include smoking & hyperlipidemia. Imaging is below. What is the diagnosis?
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Read the images before opening the teaching panel below.
Anterior Wall Ischemia
Imaging Findings
Stress and Rest SPECT images demonstrate a moderate size severe intensity reversible perfusion defect involving the mid to distal anterior wall extending into the distal anteroseptal wall and apex.
Diferential Diagnosis
Differential breast attenuation could appear similar. If breast tissue is homogenously overlying the heart at rest and is preferentially overlying the anterior wall at stress, this may appear as a reversible perfusion defect. This can best be evaluated for by reviewing the cine (raw) images. Two things can be performed to potentially correct this problem: (1) reposition the breast and rescan, (2) scan the patient in the prone position
Essential Facts
Ischemia results from decreased/blockage of blood supply to the heart due to arteriosclerosis/ rupture of calcified/noncalcified plaque
A rest stenotic coronary arteries are maximally dilated to compensate for the the presence of stenosis. At stress the vessels can not dilate further and this shows up as a relative area of decreased perfusion.
Coronarteries can increase blood flow in times of demand and this portion is at risk for myocardial infarction
Elevated Leads in V1-V6 Obstruction of the proximal left anterior descending arte
References
Montalembert, Mariane & Maunoury, C & Acar, P & Brousse, Valentine & Sidi, D & Lenoir, Geoffrey. (2004). Myocardial ischemia in children with sickle cell disease. Archives of disease in childhood. 89. 359-62. 10.1136/adc.2003.027326.
https://docs.google.com/presentation/d/17voHWaH6_tef7RNMQ5U59ZhWrgx2ttki/edit#slide=id.p31 (No References)