Nuclear Case HiSpeed

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.

Initial, Pre-Angioplasty Image: (scroll down for post-angioplasty result)

LAD_18K.jpg (18924 bytes)

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 (red arrows). This defect is present on the stress images (see the white bars at left) and largely resolves at 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.
See below for post-angioplasty result...

Post-Angioplasty result:

LAD_Post_18K.jpg (19176 bytes)

Following angioplasty, the extensive anterior perfusion defect seen on the original stress images has resolved. The patient's symptoms similarly improved.

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Lateral Wall Ischemia

Suggests blockage in the heart's Circumflex, or "left side" artery

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.

Circ_21K.jpg (22059 bytes)

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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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