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Dx for CAD s/p percutaneous coronary intervention w/ history of HTN?

she803

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Examination: Myocardial exercise stress test

History: A 53-year-old man with coronary artery disease status post percutaneous coronary intervention with history of hypertension, hypercholesterolemia, and tobacco use.

Procedure: Standard SPECT myocardial perfusion images were obtained after resting injection of 12.5 mCi of Tc-99m sestamibi. Subsequently, an intravenous infusion of 59.6 mg of dipyridamole was performed under the supervision of attending staff from the cardiovascular division. At peak pharmacologic effect of the drug, 35.4 mCi of Tc-99m sestamibi were injected intravenously and standard myocardial perfusion images were repeated. Gated wall motion and ejection fraction were derived from the stress sestamibi data.

Results: Comparison is made with previous exam performed on 6/9/2010. Stress sestamibi SPECT images demonstrate a large in size severe apical, distal anterior and anteroseptal defect. There is also a large severe inferoseptal defect. Compared to previous examination, the apical defect appears worse.

Rest thallium SPECT images demonstrate similar findings.

Gated resting sestamibi SPECT demonstrates a left ventricular ejection fraction of 35 % with apical and distal anterior anteroseptal akinesis and inferoseptal akinesis.

Impression:

Fixed apical, distal anterior and anteroseptal defect and a fixed inferoseptal defect with decreased wall motion. The findings are suggestive of scar. The thecal defect appears new since previous exam.
No ischemia.
Left mandibular ejection fraction of 35%.
 
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