Case 23

Published on 02/03/2015 by admin

Filed under Internal Medicine

Last modified 03/03/2015

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Case 23

A 61-year-old male with hypertension, hyperlipidemia, and known coronary artery disease was admitted to the hospital with worsening congestive heart failure. He suffered from a myocardial infarction in the past, for which he underwent percutaneous transluminal coronary angioplasty (PTCA). He was referred for pharmacologic stress perfusion imaging prior to consideration for a biventricular pacing ICD.

Medications: aspirin, furosemide, lisinopril, carvedilol, atorvastatin, spironolactone, and digoxin.

He underwent pharmacologic stress using 5-minute adenosine infusion protocol. His heart rate changed from 63 to 90 beats/min and blood pressure from 115/71 to 133/76 mm Hg. There was no chest pain. Baseline and peak stress ECGs are shown next. What is your interpretation?

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