Case 17
Case 17
A 53-year-old male with a history of diabetes, hypertension, hyperlipidemia, and end-stage renal disease (ESRD) presented to the hospital with chest pain and ruled-in non-ST-elevation myocardial infarction (NSTEMI). He had a renal transplant 3 years earlier, and his transplanted kidney is rejecting, with high serum urea (67 mg/dL) and creatinine levels (7 mg/dL), but he is still not on dialysis. Coronary angiography could not be done because of renal function impairment. He was treated medically and sent for rest and adenosine stress myocardial perfusion imaging (MPI) for risk stratification.
Medications: Aspirin, diltiazem, metoprolol, cyclosporine, Rapamune, calcitrol, prednisone, folic acid.
Pharmacologic stress test with 5-minute adenosine infusion is performed 99mTc-sestamibi was injected during adenosine infusion. HR changes from 55 to 71 beats/min and BP from 202/101 to 176/86 mm Hg. He has no chest pain or ST depression.
Resting ECG shows normal sinus rhythm with left axis deviation, flat T waves in leads II, III, aVF, and V4-6, with no change on adenosine infusion.
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