Nuclear Cardiology Case: A 55 year old man with positive family history (mother - MI at age 54, sister - CAD and CVA at age 50), No history of cardiac diseases, came for evaluation of CAD

A 55 year old man with positive family history (mother - MI at age 54, sister - CAD and CVA at age 50), No history of cardiac diseases, came for evaluation of CAD.
SPECT myocardial perfusion studies were performed using Thallium-201. Images representing myocardial perfusion were obtained at stress, reinjection and 4 h delayed.

Stress protocol is Treadmill / Modified Bruce
Duration of stress is 4 min 37 sec
Peak heart rate (basal --> peak) is 100 --> 134 (85%=140)
Systolic BP (basal --> peak) is 108 --> 114
Double product (peak rate x BP) is 15,300
Reason for termination is Fatigue, No chest pain
ECG findings: Upsloping ST changes

Echocardiography:

Dilated LV with severe reduction in global systolic function (EF = about 25%)
Severe hypokinesis of the anterior, septal, and apical walls, and akinesis of the inferior wall.
Mild RV enlargement with reduced RV function
2+ MR, 1+ TR

Figure 1

Figure 2: Labelled for easy identification

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Subsequent Cardiac Catheterization:

RV ESP / EDP = 64/21 mm Hg
PAP = 62/36 mm Hg
PCW = 25 mm Hg
Resting hemodynamics consistent with biventricular failure

Subsequent Coronary Angiography:

LAD - diffuse 30% stenosis; 1st diagonal branch - 70-80% stenosis
LCX - 70-80% mid-stenosis; 1st marginal branch - 60% stenosis
RCA - totally occluded in the middle portion, filled by left-to-right and right-to-right bridging collaterals

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