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Stress Test Adenosine Myoview

INDICATIONS: Ischemic cardiomyopathy, status post inferior wall myocardial infarction, status post left anterior descending PTCA and stenting.

PROCEDURE DONE: Adenosine Myoview stress test.

STRESS ECG RESULTS: The patient was stressed by intravenous adenosine, 140 mcg/kg/minute infused over four minutes. The baseline resting electrocardiogram revealed an electronic pacemaker depolarizing the ventricles regularly at a rate of 70 beats per minute. Underlying atrial fibrillation noted, very wide QRS complexes. The heart rate remained unchanged at 70 beats per minute as the blood pressure decreased from 140/80 to 110/70 with adenosine infusion.

MYOCARDIAL PERFUSION IMAGING: Resting myocardial perfusion SPECT imaging was carried out with 10.9 mCi of Tc-99m Myoview. Adenosine infusion myocardial perfusion imaging and gated scan were carried out with 30 mCi of Tc-99m Myoview. The lung heart ratio is 0.34. A large transmural inferoseptal and apical perfusion defect of severe degree noted. No evidence of perfusion abnormality along the left anterior descending territory, which was the site of a PTCA and stenting a year ago. The gated scan revealed paradoxical septal motion, dyskinetic apical segment, severe inferior hypokinesis, mild to moderate anterolateral and basilar hypokinesis. Ejection fraction is 27%.

CONCLUSIONS:
1. Findings consistent with ischemic cardiomyopathy. Paradoxical septal motion consistent with abnormal ventricular depolarization related to right ventricular apical position of VVI pacemaker. Apical dyskinesis, severe inferior hypokinesis, mild to moderate anterolateral and basilar hypokinesis. Ejection fraction of 27%.
2. Large inferoseptal and apical transmural scar.
3. No evidence of adenosine-induced myocardial ischemia. Specifically no reversible perfusion abnormalities seen in the territory of the left anterior descending, which underwent stenting a year ago.