Clinical Presentation

A 60-year-old man is referred for the evaluation of atypical chest pain. There is no known prior cardiac history. The only risk factor for coronary artery disease is obesity. He is not on cardiac medications.

Fig. 33.1

Technique

• The patient had nothing to eat within 4 hours of the test.

• Rest images were acquired 40 minutes after the intravenous injection of 10 mCi of ^99mTc-sestamibi.

• Images were acquired in the supine position with a two-headed gamma camera with step-and-shoot rotation, 32 projections over a 90-degree arc for each head (64 projections over a 180-degree arc), 30 seconds per projection, and a 64 × 64 matrix.

• Exercise: 10 minutes, 40 seconds on a Bruce protocol (12.8 METs [metabolic workloads]).

• Heart rate, blood pressure, and 12-lead ECG were recorded at baseline and every minute thereafter during stress.

• A 33 mCi dose of ^99mTc-sestamibi was injected during peak stress.