Published on 02/03/2015 by admin
Filed under Internal Medicine
Last modified 02/03/2015
This article have been viewed 886 times
Case 1
A 68-year-old man with a history of hypertension presented to the emergency department for evaluation of new-onset weakness and diaphoresis. He denied chest pain. He had no other coronary disease risk factors.
Laboratory examination was normal except for leukocytosis (WBC = 22,000). He left against medical advice but returned 2 days later for persistent symptoms. Exercise SPECT MPI was requested.
The baseline ECG shows normal sinus rhythm with slightly increased QRS voltage consistent with left ventricular hypertrophy.
He exercised on a Bruce protocol for 6:32 minutes, achieving an estimated workload of 7.7 METs. The peak exercise heart rate was 146 beats/min (96% of maximum age-predicted heart rate). No chest pain was reported, and the blood pressure response to exercise was normal.
The peak exercise ECG demonstrated sinus tachycardia with 4 mm of downsloping ST-segment depression suggestive of ischemia.
The postexercise (above) and resting (below) raw images are shown. Image quality appears adequate.
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