Nuclear Cardiology Case: A 53-year-old man with family history of coronary artery disease presented with CHF and ECG evidence of silent anterior wall MI

A 53-year-old man with family history of coronary artery disease presented with CHF and ECG evidence of silent anterior wall MI. We have to evaluate for extent and severity of ischemia. SPECT myocardial perfusion studies were performed using Tc-99m-Sestamibi. Images representing myocardial perfusion were obtained at rest and peak stress.

Stress protocol used is Treadmill / Bruce
Duration of exercise is 5 min 25 sec
Peak heart rate (85%) is 84 -- 131 (85%=142)
Systolic BP (basal -- peak) is 115 -- 155
Double product (peak rate x BP) is 20,300
Reason for termination is Dyspnea. Fatigue.
No chest pain
ECG findings are ST-T abnormalities at rest, pseudo-normalization

Subsequent Coronary Angiography showed: 

LAD - 90% stenosis
RCA - 40-50% stenosis
LCx - Normal
Anterior wall hypokinesis
LVEF=54%

Echocardiography: 

Hypokinesis / akinesis of the anterior septal and anterior apical portions of the myocardium LVEF=48%

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