Case 30

Published on 02/03/2015 by admin

Filed under Internal Medicine

Last modified 02/03/2015

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Case 30

A 61-year-old overweight male (6 feet tall, weight 280 pounds) presented with a history of progressively worsening shortness of breath over the last month. At admission, he was found to be in atrial fibrillation. He had a remote history of smoking and recent heavy drinking. He was referred for a pharmacologic stress test. He was taking heparin, aspirin, and digoxin.

He underwent 2-day imaging protocol because of his overweight. Rest imaging was done on the first day, using 30 mCi of technetium-99-sestamibi. He underwent pharmacologic stress using 5-minute adenosine infusion protocol on the second day. His heart rate changed from 101 to 89 beats/min and blood pressure from 178/100 to 189/100. He did not complain of chest pain. His ECG showed atrial fibrillation, left axis deviation, and nonspecific T-wave flattening. There was no further change with adenosine infusion.

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