History:

Known IHD, CABG 2003. Recent symptoms of angina.

The resting ECG showed sinus rhythm, LAD. During exercise there was down sloping ST segment depression in V6 at peak stress. These changes became more positive in the recovery period though slowly responded to O2, GTN and Aminophylline reversal.

Stress perfusion scan:
Moderately large defect in the distal anterior wall and apex.
Rest perfusion scan (following sublingual GTN): Normal.
Gated Images: Post CABG wall motion changes in the septum with mildly reduced septal thickening (normal>50%). Estimated LVEF 50%.

Conclusion:
Positive ECG changes in the absence of chest pain on dipyridamole infusion (with exercise).

The myocardial perfusion scan demonstrates a moderately large area of inducible ischaemia in the anterior wall and apex (LAD territory).

The resting left ventricular ejection fraction is at lower limits of normal.

History::

The same patient then went on to have a stent following the abnormal perfusion study, but now complained of exertional dyspnoea with possible nocturnal angina.

The resting ECG showed SR with ST segment flattening in the lateral leads. During this stress test there were no ischaemic changes.

Stress perfusion scan:
Subtle perfusion defect was seen in the basal anterior wall (estimated at 5% of the LV) with a further small abnormality in the distal anterior wall towards the apex.
Rest perfusion scan (post s/l GTN): Normal.
Gated Images: Post CABG wall motion changes in the septum. Function was otherwise normal with an estimated LVEF of 60% (normal >50%).

Conclusion:
When compared to the prior study of September 2005 there has been marked improvement to perfusion in the anterior wall, apex and septum. The myocardial perfusion scan does show however a small area of inducible ischaemia in the basal anterior wall (vascular territory unclear though probably a branch of the LAD). There is possibly a 2nd small area of ischaemia in the antero-apical region.
The resting left ventricular systolic function appears normal..

QGS Display page:
This page demonstrates any reversible areas of myocardium and the corresponding vessel supply to that area.

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QPS Display page:
This page demonstrates the cardiac wall motion to demonstrate any areas that have decreased function.

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