Acute coronary syndrome, no evidence of MI by ECG or enzymes.
Echo with WM abnormalities. -Submitted for myocardial perfusion study (MPS) with pharmacologic test.
Dipyridamole (0.56 mg/Kg) + rest in 2-day protocol with 99mTc-MIBI.
Teaching points:
Post-stress decrease in LVEF and/or increase in ESV are strong predictors of cardiac events.
Transient ischemic dilation (TID) of the LV and a relative drop in post-stress LVEF may represent myocardial stunning.
In this patient, these findings were associated with 2-vessel disease (including 90% LAD stenosis).
LV volumes should be considered when interpreting a gated SPECT study. However, abnormal volumes should be reported with caution since significant differences could be obtained using different software packages.
