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Examples of Nuclear Perfusion Studies |
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Reversible
Perfusion Defects... Ischemia: |
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Inferior Wall Ischemia:
[Also
known as blockage in the heart's bottom artery] |
| Case History: This
64 year old man complained of discomfort to the mid-chest occuring with exertion. His
medical history includes high blood pressure and hyperlipidemia (high-risk cholesterol
profile).
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| Perfusion
imaging using dual-isotope Technetium-99m Sestamibi (Cardiolyte) and thallium tracers
demonstrates a significant reversible perfusion defect in the inferior wall (red arrows).
This defect is present during stress (the 1st, 3rd and 5th rows from
top- white bars at left) and resolves with rest (see the 2nd, 4th and 6th rows-- red bars
at left). Reversible defects indicate ischemia, or a reduction of blood flow with
increasing metabolic demands. The fact the the resting images return to normal
(reverse) indicates that there has been no permanent injury to the heart muscle This patient underwent Cardiac Catheterization that showed a
high grade blockage to his right coronary artery. Successful angioplasty with stent placement was
performed, reducing the severity of the lesion from 90 percent to less than 10
percent. His chest discomfort did not recur.
Importantly, his risk factors for progression of coronary
artery disease were addressed. The high blood pressure was treated with medication
as was the hyperlipidemia. He was discharged home on the day following his
procedure. |
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Anterior Wall Ischemia:
[blockage
in the Left Anterior Descending Artery] |
| Case History: This
72 year old woman described a heaviness to the mid-chest which was relieved by
nitroglycerine tablets. Lately, the discomfort was occurring more frequently, and
sometimes while at rest. She smokes cigarettes and gives a history of coronary
artery disease in her two brothers.
See nuclear perfusion imaging (at right:) |
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and post-angiplasty images
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| Dual
isotope perfusion imaging shows a large reversible perfusion defect in the anterior wall,
the apex (or tip of the heart) and the distal inferior wall (see red arrows). This
defect is present during the stress images, denoted by the white bars to the left.
It largely resolves with rest (rows of images with red bars at left). This large
defect in the anterior wall of the heart suggests a significant stenosis, or blockage, of
the Left Anterior Descending coronary artery. Cardiac Catheterization confirmed
this, and angioplasty with primary stent placement
was performed. Click below the image to view improved perfusion study following
angioplasty. |
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Lateral Wall Ischemia:
[Blockage in
the Circumflex, or "left side" artery]
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| Case History: This
48 year old diabetic man noted increasing shortness of breath with activities. He
denied symptoms of chest discomfort. His Type I diabetes was longstanding, and
complicated by kidney dysfunction.
See nuclear perfusion imaging (at right:) |
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| Dual-isotope
perfusion imaging using Technetium-99m Sestamibi and thallium tracers shows a large
reversible perfusion defect in the anterolateral and inferolateral walls (red arrows).
This defect is present during stress (the 1st, 3rd and 5th rows from
top- white bars at left) and resolves with rest (see the 2nd, 4th and 6th rows-- red bars
at left). Careful inspection also reveals reversible perfusion defects in the
inferior (bottom) wall as well as portions of the anterior (top) wall. Reversible
defects indicate ischemia, or a reduction of blood flow with increasing metabolic demands.
Cardiac Catheterization was performed,
showing severe stenoses (blockages) in all three major coronary arteries. The
circumflex, or side, artery was the most severely narrowed. Also, the Left Anterior
Descending and the Right Coronary Artery were significantly affected. He
underwent uneventful three vessel coronary artery bypass surgery. Ventricular (heart
muscle) function was normal after the surgery, suggesting that no permanent injury had
occurred. |
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