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Human Health Campus
Human Health Campus
Human Health Campus

Dyspnea and chest pain at exertion

Teaching Case

Case presentation:

  • Male.
  • 63 y.o.
  • Hypertension.
  • Dyspnea and chest pain when exercising, progressive.
  • Normal rest ECG. - Stress echo: poor acoustic window, technically suboptimal.
  • Myocardial perfusion study with exercise (99mTc-sestamibi). -Stress test: Chest pain, mild ECG changes, drop in SBP.

Teaching points:

  • Post-stress increased RV uptake has prognostic implications and can reflect RV pressure overload due to postischemic LV dysfunction.
  • Post-stress increased RV activity can be also an indicator of stress-induced RV:LV perfusion imbalance associated with severe CAD (e.g., high-grade left main stenosis with less severe proximal right CAD stenosis).
  • The amount of inducible ischemia, transient dilation of the LV, LVEF post-stress & rest, and reversible regional wall motion abnormalities are other major indicators of poor prognosis (predictive parameters of cardiac events).

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