MYOCARDIAL SPECT PERFUSION STUDY

CLINICAL HISTORY:  The patient is a [...]-year-old [fe]male with a history of [...]. Now referred to Nuclear Medicine for evaluation of possible stress induced ischemia.

COMPARISON: None

Mode of Stress: Adenosine [40] mg

TECHNIQUE: After injection of technetium 99m Sestamibi, resting SPECT images of the heart were acquired.  Subsequently, 99mTc Sestamibi was injected at peak stress and gated SPECT images of the heart were obtained.

RADIOPHARMACEUTICAL DOSE:  99m Tc Sestamibi Rest: [8] mCi, Stress: [25] mCi

FINDINGS:

STRESS RESPONSE:  The patient exercised according to the ADENOSINE for 4:00 minutes. The resting heart rate of [...] bpm rose to a maximal heart rate of [...] bpm. This value represents [...]% of the maximal, age-predicted heart rate. The resting blood pressure of [...] mmHg, rose to a maximum blood pressure of [...] mmHg. The test was stopped due to completion of the protocol.

MYOCARDIAL PERFUSION STUDY:

Left ventricular chamber size: Normal.

PERFUSION WITH STRESS: Normal perfusion to all walls of the left ventricular myocardium. Mild decrease in tracer activity in the proximal to mid inferior wall. Moderate to severely decreased tracer activity in the proximal to distal inferior wall extending into the inferoapical region. Homogeneous normal activity in the remainder of the left ventricular myocardium.

PERFUSION AT REST: Normal. Unchanged from perfusion with stress. The fixed defect of the inferior wall is most likely due to diaphragmatic attenuation. The fixed defect of the distal anteroseptal wall is most likely due to breast attenuation. 
 
Gated study 15-20 minutes post stress: Normal motion and wall thickening. Mild septal hypokinesis consistent with the patient's history of CABG.

Estimated left ventricular ejection fraction: [...]%.

Comparison with the previous myocardial perfusion scan indicates that there has been no significant interval change.

CONCLUSIONS: 

1. Normal rest/stress perfusion study with no scintigraphic evidence for stress induced ischemia or prior myocardial infarction.

2. The left ventricle is of normal size and demonstrates normal wall motion with an estimated ejection fraction of [...]%.

3. No significant interval change compared to the previous myocardial perfusion scan.

3. When compared with the previous examination, there has been no appreciable change.

1. Fixed perfusion defect in the inferior wall extending into the apex which is consistent with prior infarction in the RCA territory. There is no evidence for stress induced ischemia.

2. Enlarged LV size with wall motion abnormalities as noted above. Estimated left ventricular ejection fraction is [...]%.

3. The above findings suggest a non-ischemic process as the underlying cause of the patient's congestive heart failure.

1. This is an abnormal rest/stress myocardial perfusion study with a partially reversible perfusion defect of moderate severity in the mid to distal anterior wall including the apex, consistent with stress-induced ischemia in the LAD territory.  The partial reversibility suggests myocardial damage in the antero-apical region.

2. The left ventricle is moderately enlarged and demonstrates decreased function with wall motion abnormalities described above, and an estimated ejection fraction of 21%.