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Sample Site
Stress/Rest Myocardial Perfusion
Patient Name: Cta fv3d, Pet_cardiac
Date of Study: 2003-11-21
FusedVision3D
Age: 81
Sex: M
Outpatient
w
ID Number:
This letter reflects our overall impression of the results of the Stress/Rest Myocardial Perfusion study and the stress
electrocardiogram combined with the patient’s age, sex, symptoms, and coronary risk factors. The study was
performed in order to evaluate coronary artery disease in this 81 year old male with a history of prior myocardial
infarction (2000), bypass, aortic valve surgeries with the most recent being done on (5/2001), previous positive
treadmill, valve disease and coronary artery disease by referring physician. Symptoms include atypical chest pain.
Risk factors include hypercholesterolemia and hypertension. At the time of testing, the patient was under the influence
of a beta blocker. The patient is currently taking CA++ blockers and HMG CoA reductase inhibitor.
Exercise duration was 5:15 minutes to a heart rate of 102 (73% of maximum predicted). Exercise was terminated
because of achievement of adequate heart rate. Chest discomfort occured at 4 minutes into recovery. The resting
blood pressure was 80/120 and maximum blood pressure was 90/130. The resting ECG showed atrial flutter, A/V
sequential pacing, possible inferoposterior myocardial infarction, possible anteroseptal myocardial infarction, Early
repolarization and left posterior fascicular block. The stress ECG revealed -2.5mm horizontal ST depression in lead
V5 and -5.3mm downsloping ST depression in lead AVF.
●
Exercise separate aquisition dual isotope gated myocardial perfusion SPECT (stress sestamibi/rest thallium)
demonstrated overall defects as follows:
Vessel
Reversible
Nonreversible
RCA
small to medium (inferoseptal)
LAD
small to medium (anterior)
There was transient ischemic dilation of the left ventricle (more enlargement of the LV at stress compared to rest)
which is a marker of severe and extensive coronary artery disease. Sestamibi SPECT was performed in the supine
position.
●
Resting gated SPECT revealed an ejection fraction of 50% with end-diastolic volume of 120 ml. Post Exercise
resting gated SPECT revealed a mildly reduced left ventricular ejection fraction of 45% with end-diastolic volume
of 120 ml. Left ventricular wall motion demonstrated severe dyskinesis of the interventricular septum with normal
thickening, consistent with prior sternotomy or paced rhythm. Furthermore, there was dyskinesis in the septal wall
and moderate hypokinesis in the anterior wall.
ev
ie
●
Pr
In conclusion, the test results are as follows:
Clinical Response: Ischemic
ECG Response: Ischemic
Perfusion: Abnormal (Reversible and Nonreversible)
Gated Function: Abnormal
These test results indicate a high intermediate (70-89%) likelihood for the presence of exercise induced ischemia. The
type and distribution of the scintigraphic abnormalities are most consistent with the following: in the RCA territory, a
small to medium amount of severe ischemia in the inferoseptal wall; in the LAD territory, a small to medium sized
prior myocardial infarction involving the anterior wall. In view of the normal perfusion and function and
electrocardiogram at peak exercise, the development of chest pain during exercise is of uncertain significance.
Thank you for referring this patient to us.
Sincerely yours,
-Preview Only-
Stress ECG interpreted by Sample Physician
Date printed: 2005-3-9 11:40
Cardiology
Fax (800) 555-1212
Phone (800) 555-1212
Sample Site
Myocardial Perfusion SPECT
Patient Name: Cta fv3d, Pet_cardiac
Date of Study: 2003-11-21
FusedVision3D
Age: 81
Sex: M
Short Axis
Apical Level
Outpatient
Short Axis
Mid-Ventricular
Short Axis
Basal Level
3
5
Infero
Lateral
4
8
12
9
11
14
15
10
2. AnteroSeptal
3. InferoSeptal
4. Inferior
5. InferoLateral
6. AnteroLateral
3
0
0
0
0
0
S R
3
0
0
0
0
0
7. Anterior
8. AnteroSeptal
9. InferoSeptal
10. Inferior
17
20
3
0
3
0
0
0
3
0
0
0
0
0
S R
11. InferoLateral
12. AnteroLateral
%SS : 15 (severe)
Antero
Apical
13. Anterior
14. AnteroSeptal
15. InferoSeptal
16. Inferior
0
0
3
0
0
0
0
0
0
0
0
0
17. InferoLateral
18. AnteroLateral
Infero
Apical
Reversible
Nonreversible
S R
19. AnteroApical
20. InferoApical
ev
1. Anterior
19
16
Inferior
S R
18
ie
Infero
Septal
6
13
7
Antero
Lateral
1
2
Vertical Long Axis
Normal
Anterior
Antero
Septal
w
ID Number:
0 0
0 0
0 = Normal
1 = Mildly reduced/
Equivocal
2 = Moderaty
Reduced
3 = Severely
Reduced
4 = Absent
Uptake
S = Stress R = Rest
%RS : 8 (mild)
%DS : 8 (moderate)
Exercise separate aquisition dual isotope gated myocardial perfusion SPECT using Tc-99m sestamibi (35.9 mCi) at stress
and thallium-201 (2.6 mCi) at rest was performed using the rest/stress sequence. Sestamibi SPECT was performed in the
supine position.
Pr
Findings: overall defects as follows:
Vessel
Reversible
RCA
small to medium (inferoseptal)
LAD
Nonreversible
small to medium (anterior)
There was transient ischemic dilation of the left ventricle (more enlargement of the LV at stress compared to rest) which
is a marker of severe and extensive coronary artery disease.
Myocardial perfusion test result: Definitely abnormal with both reversible and nonreversible defects.
%SS (Percent Stress)
Normal
Mild
Moderate
Severe
0-4%
5-9%
10-14%
>14%
Date printed: 2005-3-9 11:40
%RS (Percent Fixed)
Normal
Mild
Moderate
Severe
0-4%
5-9%
10-14%
>14%
%DS (Percent Ishemic)
Normal
Mild
Moderate
Severe
0-2%
3-5%
6-9%
> 9%
Vessel Descriptions
RCA (Right Coronary Artery)
LAD (Left Anterior Descending)
LCX (Left Circumflex)
DIAG (Diagonal)
Sample Site
Ventricular Function Gated SPECT
Patient Name: Cta fv3d, Pet_cardiac
Date of Study: 2003-11-21
FusedVision3D
Age: 81
Sex: M
Short Axis
Apical Level
Outpatient
Short Axis
Mid-Ventricular
Short Axis
Basal Level
6
3
5
4
13
7
Antero
Lateral
Infero
Lateral
8
12
9
11
14
15
10
2. AnteroSeptal
3. InferoSeptal
4. Inferior
5. InferoLateral
6. AnteroLateral
2
5
5
0
0
0
2
5
5
0
0
0
S R
7. Anterior
8. AnteroSeptal
9. InferoSeptal
10. Inferior
17
20
2
5
5
0
0
0
2
5
5
0
0
0
S R
13. Anterior
14. AnteroSeptal
15. InferoSeptal
16. Inferior
0
5
5
0
0
0
0
5
5
0
0
0
ev
1. Anterior
19
16
Inferior
S R
18
11. InferoLateral
12. AnteroLateral
LV Ejection Fraction
Rest: 50% Post Stress: 45%
Antero
Apical
ie
Infero
Septal
1
2
Vertical Long Axis
Normal
Anterior
Antero
Septal
w
ID Number:
17. InferoLateral
18. AnteroLateral
Infero
Apical
Moderate /
Severe
Hypokinesis
Akinesis
Dyskinesis
S R
19. AnteroApical
20. InferoApical
0 0
0 0
0 = Normal
1 = Mild
Hypokinesis
2 = Moderate
Hypokinesis
3 = Severe
Hypokinesis
4 = Akinesis
5 = Dyskinesis
S = Stress R = Rest
End-diastolic volume
Rest: 120 ml Post Stress: 120 ml
Pr
Findings: Definitely Abnormal
Resting gated SPECT revealed an ejection fraction of 50% with end-diastolic volume of 120 ml. Post Exercise resting
gated SPECT revealed a mildly reduced left ventricular ejection fraction of 45% with end-diastolic volume of 120 ml.
Left ventricular wall motion demonstrated severe dyskinesis of the interventricular septum with normal thickening,
consistent with prior sternotomy or paced rhythm. Furthermore, there was dyskinesis in the septal wall and moderate
hypokinesis in the anterior wall.
Date printed: 2005-3-9 11:40
Sample Site
Stress Electrocardiography
Patient Name: Cta fv3d, Pet_cardiac
Date of Study: 2003-11-21
FusedVision3D
Age: 81
Sex: M
Outpatient
w
ID Number:
A standard 12 LEAD ELECTROCARDIOGRAM was recorded with continous ECG monitoring throughout exercise and recovery. Additionally, 12 LEAD
ELECTROCARDIOGRAMS were recorded every minute.
Stress Physiology
Exercise Duration
5:15
Heart Rate
Rest: 80
Blood Pressure
Rest: 80/120
Exertional Hypotension
No
Discomfort
Yes
Pain location
Chest
Arrthythmia
None
Reason for termination
achievement of adequate heart rate
ie
% Maximal Predicted Heart Rate: 73%
Exercise: 90/130
Onset of Pain: Stress minute 3.6
ev
Resting Electrocardiogram
Exercise: 102
atrial flutter, A/V sequential pacing, possible inferoposterior myocardial infarction, possible anteroseptal
myocardial infarction, Early repolarization and left posterior fascicular block
V5
AVF
III
Maximum Abnormality: -2.5mm horizontal
ECG First became Abnormal:Recovery minute 3
Maximum Abnormality-5.3mm downsloping
ECG First became Abnormal:Exercise minute 2
Maximum Abnormality: None
ECG First became Abnormal:
No. of leads with significant S-T depression: 0
Impression
Pr
Clinical response to Stress: Ischemic due to chest discomfort
ECG response to Stress: Ischemic due to the development of significant ST segment depression
Stress ECG interpreted by Sample Physician
Date printed: 2005-3-9 11:40