Case 18

Published on 02/03/2015 by admin

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Last modified 02/03/2015

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Case 18

A 54-year-old woman with inadequately controlled hypertension for the last several years complains of exertional angina at the outpatient office and is referred for pharmacologic stress/rest perfusion imaging. She is on oral atenolol 50 mg per day.

She underwent 2-day rest/stress ^99mTc-sestamibi perfusion imaging using 5-minute adenosine infusion as an outpatient study. Her heart rate increased from 83 to 93 beats/min and blood pressure from 185/99 to 179/98 mm Hg. She developed anginal chest pain during adenosine infusion. Her baseline and peak stress ECGs are shown. What is your interpretation?

(Fig. 1a)

(Fig. 1b)

There is normal sinus rhythm with Q waves in aVL and V2, with T-wave inversion in leads aVL and V2-3. There is left ventricular hypertrophy. There is no ST-segment depression with adenosine infusion.

(Video 1a)

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