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

Comments

𝘼𝙣𝙩𝙞𝙘𝙤𝙖𝙜𝙪𝙡𝙖𝙩𝙞𝙤𝙣 𝘼𝙛𝙩𝙚𝙧 𝙎𝙩𝙧𝙤𝙠𝙚

𝘼𝙣𝙩𝙞𝙘𝙤𝙖𝙜𝙪𝙡𝙖𝙩𝙞𝙤𝙣 𝘼𝙛𝙩𝙚𝙧 𝙎𝙩𝙧𝙤𝙠𝙚 in Patient with AF and acute IS/TIA European Heart Association Guideline recommends: • 1 days after TIA • 3 days after mild stroke • 6 days after moderate stroke • 12 days after severe stroke Early anticoagulation can decrease a risk of recurrent stroke and embolic events but may increase a risk of secondary hemorrhagic transformation of brain infarcts. The 1-3-6-12-day rule is a known consensus with graded increase in delay of anticoagulation between 1 and 12 days after onset of ischemic stroke or transient ischemic attack(TIA), according to neurological severity based on European expert opinions. However, this rule might be somewhat later than currently used in a real-world practical setting.

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