Case 33

Published on 02/03/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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Case 33

A 60-year-old male with coronary artery disease suffered from an inferior wall myocardial infarction 2 years earlier and underwent staged percutaneous coronary intervention (PCI) of the completely occluded left circumflex and right coronary arteries. He presents now with complaints of chest pain.

Medications: ramipril, isosorbide mononitrate, aspirin, atorvastatin, and clopidogrel.

Pharmacologic stress test was performed with 5-minute adenosine infusion. His heart rate changed from 74 to 80 beats/min and blood pressure from 100/60 to 90/60 mm Hg. He had no chest pain or ST changes. He had Q waves in inferior leads, with no change with adenosine infusion. ^99mTc-sestamibi was used for stress-rest perfusion imaging.

(Video 1a)

(Video 1b)

(Fig. 1a)

(Fig. 1b)

(Fig. 1c)

(Video 2)

(Fig. 2)

Myocardial perfusion imaging shows a large, dense scar involving the inferior and lateral walls. Left ventricular ejection fraction is 37%. Inferior and lateral walls are akinetic.

This patient underwent successful PCI of the left circumflex and the right coronary arteries. However, there is a large dense scar involving these vascular territories.

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