October 2010

History


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  • 72 year old female, 81 kg
  • Exertional chest pain – typical of angina
  • Hypertensive
  • Inconclusive ETT (terminated early due to dyspnoea)

Stress Protocol

  • Adenosine (140mcg/kg/min over 4.5 minutes) and low workload exercise
  • No chest pain/dyspnoea

Rest ECG and peak stress ECG

Q – What is the significance of the ECG changes?

MPS images

Click here for the splash image of MPS data

Q - What are the salient findings on the perfusion study?

Answers

ECG - Abnormal ST depression suggesting ischaemia

  • In isolation i.e. a normal perfusion study with vasodilator induced ST depression, is associated with higher incidence of hard cardiac events and would warrant further evaluation. 

 MPS - Stress induced LV cavity dilation (TID ratio > 1.3)

  • Ischaemia in several segments particularly in the left circulation and to a lesser extent RCA territory.
  • Consistent with multivessel ischaemia

Follow up

  • This patient’s angiogram confirmed significant LAD and RCA disease

Teaching points

  • ST depression during Adenosine infusion (in isolation) is associated with a higher incidence of hard cardiac events and maybe an indicator of Multi Vessel Disease (MVD)
  • Occult markers of MVD include:
  1. Relative RV prominence post stress
  2. Stress induced LV cavity dilation or Transient ischaemic dilation (TID)

    Page last edited: 24 November 2010