Clinical Presentation

A 56-year-old woman without a known cardiac history is referred for the evaluation of exertional chest pain. Her risk factors include hypertension and obesity. She is being treated with atenolol and amlodipine.

Fig. 37.1

Technique

• The patient had nothing to eat within 4 hours of the test. The β-blocker was withheld on the day of the test.

• On day 1, the patient exercised for 4 minutes on a Bruce protocol and achieved 96% of the age- predicted maximal heart rate. Heart rate, blood pressure, and 12-lead ECG were recorded at baseline and every minute thereafter during exercise.

• A 32 mCi dose of ^99mTc-sestamibi was injected during peak stress.