Nuclear Cardiology Case: A 50 year old man history of NIDDM, renal artery stenosis and longstanding hypertension now presented with CHF

A 50 year old man history of NIDDM, renal artery stenosis and longstanding hypertension now presented with CHF. You have to evaluate him for ischemia.
SPECT myocardial perfusion studies were performed using Tc-99m-Sestamibi and Persantine. Images representing myocardial perfusion were obtained at rest and peak stress.

Stress protocol = Persantine
Duration of stress = 4 min
Peak heart rate (basal --> peak) = 72 --> 87 (85%=144 )
Systolic BP (basal --> peak) = 166 --> 120
Double product (peak rate x BP) = 10,520
Reason for termination = Protocol achieved. No chest pain
ECG findings = No ST changes

Figure 1

Figure 2: Labelled for easy identification

Subsequent Echocardiography:

LV dilatation with severe reduction in systolic function
EF=15-20%
Mild mitral regurgitation (1+)
Left atrial enlargement

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