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What Causes "Train Track Pattern" on Device Tracings

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Case in Nuclear Cardiology: A 61-year-old woman with history of CAD, status post multiple PTCAs, and laser angioplasty of proximal LAD, presented with recurrent chest pain

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A 61-year-old woman with history of CAD, status post multiple PTCAs, and laser angioplasty of proximal LAD, presented with recurrent chest pain for the past few weeks to be evaluated for ischemia. SPECT myocardial perfusion studies were performed using Tc-99m-Sestamibi. Images representing myocardial perfusion were obtained at rest and peak stress.
  • Stress protocol is Treadmill / Bruce
  • Duration of stress is 4 min 57 sec
  • Heart Rate (basal --> peak) is 53 --> 88 (85%=134)
  • Systolic BP (basal --> peak) is 130 --> 134
  • Double product (peak rate x BP) is 11,800
  • Reason for termination is Typical chest pain
  • ECG finding is 1 mm ST depression
Review the following images and interpret the data:


Subsequent Coronary Angiography: 

LAD - 30-40% proximal stenosis, 1st marginal branch - 40% proximal stenosis
LCX - Totally occluded distally
OM - 95% stenosis
RCA - Small and totally occluded (non-dominant)


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