Nuclear Cardiology Case: A 63-year-old man, known multivessel CAD. Evaluate the severity of ischemia

A 63-year-old man, known multivessel CAD. To evaluate the severity of ischemia in this patient. SPECT myocardial perfusion testing was 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 12 min
• Peak heart rate (85%) is 85 --> 150 (85%=133)
• Systolic BP (basal --> peak) is 150 --> 160
• Double product (peak rate x BP) is 24,000
• Reason for termination is Dyspnea.
• Typical chest pain
• ECG finding is 1 mm ST depression 

Figure 2 with labelled pathology for clarification

Subsequent Coronary Angiography: 

RCA - totally occluded, left to right collaterals
LAD - 50% proximal stenosis
LCX - 1st marginal branch - 70% stenosis ,1st diagonal branch - 70-80% distal stenosis
Left ventricular ejection fraction = 57%

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