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).