Indigestion type chest pain? Nuclear Medicine case study
This patient was an 82 year old gentleman who had been experiencing chest discomfort with exertion, which this patient described as an ‘indigestion feeling in the upper chest while doing some exertion’. The patient referred by a General Practice and was is documented as having high blood pressure and was referred for a Myocardial Perfusion Study querying Coronary Artery Disease.
The stress test component of the study saw this patient undergo 6 minutes of exercise through the Bruce protocol, limited by fatigue and dyspnoea on the treadmill reaching stress maximum workload stage II. This patient demonstrated a normal resting ECG. The stress 12 lead ECG shows horizontal ST segment depression in precordial and inferior leads becoming downsloping in recovery phase. Maximum ST segment depression 4.2 mm lead V6, and no arrhythmia was documented during the course of the study.
Imaging shows a prominent reversible perfusion abnormality involving the anterior wall, anteroseptal segment, lateral wall and cardiac apex left ventricle. This evidence of exercise induced ischemia corresponds to the vascular distribution of LAD and circumflex coronary arteries.
Upon completing the study, our Radiologist on site, personally escorted this patient directly to Lismore Base Hospital for further care.
Relative to exercise treadmill tests, MPS provides far higher Sensitivity (89% vs 67%) and higher specificity (75% vs 70%) for angiographically significant CAD. This difference is maximal for patients with intermediate risk for CAD.1
MPS provides important information about the function of the heat and compliments the anatomical detail provided by Cardiac CT, therefore providing greater risk assessment and diagnosis leading to improved patient outcomes.
Cost – Bulk Billed
Availability – Monday, Tuesday and Wednesdays at NCR Nuclear Medicine, Level 2, St Vincents Hospital, Lismore
Referral – MPS can be referred by a GP as an initial screening for CAD prior to seeing cardiologist.
Contact Details – Nuclear Medicine team 02 6625 9370
- Gibbons RJ et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). 2002;106:1883–92.