The patient is a 58-year old male with a history of coronary artery disease, syncope, hypertension, hypercholesterolemia, diabetes mellitus, family history of coronary artery disease, former tobacco smoker, status post CABG x4 four years prior to this study.

• Perfusion Stress:

  Moderate decrease in tracer activity in the proximal to distal inferolateral wall.

  Moderate to severe decreased tracer activity in the proximal inferior wall.

  Normal perfusion to the rest of the left ventricular myocardium.

• Perfusion Rest:

  When compared with stress perfusion images decreased tracer activity in the inferolateral wall is improved but not completely normalized.

• LVEF: 46%.

• Regional wall motion analysis:

  Proximal inferior wall hypokinesis. Septal hypokinesis consistent with prior history of CABG.

• Abnormal rest/stress myocardial perfusion study, with a reversible perfusion defect in the proximal to distal inferolateral wall consistent with stress-induced ischemia in the LCX territory. There is fixed perfusion defect in the proximal inferior wall consistent with prior myocardial infarction in the RCA territory.

• The left ventricle is mildly dilated and shows mildly decreased systolic function with wall motion abnormalities described above.