Single episode of chest pain at rest in an elderly patient

Case presentation:

• Female
• 83 y.o.
• No coronary risk factors. No previous history of CAD.
• Episode of chest pain at rest, with normal EKG and enzymes. The symptoms resolved spontaneously, and the patient was discharged.
• Since the patient was unable to exercise, the cardiologist ordered a myocardial perfusion study (MPS) with pharmacologic stress.

Teaching points:

• MPS is safe and has prognostic incremental value in elderly patients and may influence medical decisions.
• High risk features like TID, ESV increase and LVEF decrease during stress, indicate the need for intervention rather than medical treatment.
• Women with severely abnormal scan results are at increased risk for hard cardiac events than are men with same results.
• Ischemia in the LAD territory could be predicted by the result of the test.