LEARN NUCLEAR MEDICINE
Cardiology · Case 03
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
42 year old man with chest pain undergoes Lexiscan myocardial stress test. Non-attenuation correction images are followed by attenuation correction images.
Read the images before opening the teaching panel below.
Inferior Wall Ischemia
Imaging Findings
At stress there is a perfusion defect involving the entire inferior wall extending, which is reversible when compared to the resting images. This defect persist with attenuation correction.
Diferential Diagnosis
Differential diaphragm attenuation could appear similar.; however, the severity of the findings and lack of improvement with attenuation correction favors ischemia. An attempt could have been made to place this patient in the prone position to see if altering the patient’s position resolved the perfusion defect. If there was high clinical suspicion that this was a false positive the patient could have undergone a repeat stress test with PET imaging.
Essential Facts
Ischemia is the decreased/blockage of blood supply to the heart due to arteriosclerosis/ rupture of calcified/non-calcified plaque
A resting heart is maximally dilated to compensate for the the heart when at stress
Relative perfusion defect
Coronarteries can increase blood flow in times of demand and this portion is at risk for myocardial infarction
Suggestive Symptoms to Inferior Wall
Epigastric Pain
Elevated Leads in II, III, aVF
Obstruction of the left circumflex branch or right coronary artery
Nitric Oxide and PDE5 are specifically contraindicated in inferior wall ischemia
References
“Case 84.” Nuclear Medicine Case Review Series, by Harvey A. Ziessman, Elsevier, 2011, pp. 171–172.
https://docs.google.com/presentation/d/1S25rPg9YYMF3r-DoaSxZxEhEujCEbVZx/edit#slide=id.p2 (No References)
“Naylor Association Management Software.” American Society of Nuclear Cardiology, Naylor Association Management Software, www.asnc.org/content.asp?contentid=292#I
“AMBOSS Database.” AMBOSS Login, next.amboss.com/us/article/wS0hbf.
https://docs.google.com/presentation/d/17voHWaH6_tef7RNMQ5U59ZhWrgx2ttki/edit#slide=id.p31 (No References)