Case presentation:

• Male.
• 73 y.o.
• Previous myocardial infarction, heart failure.
• Submitted for myocardial viability assessment.
• Myocardial perfusion study with 99mTc-sestamibi at rest and after nitrates.

Teaching points:

• Myocardial viability studies are important in patients with heart failure and coronary heart disease in order to identify patients in whom either CABG or PTCA could result in functional recovery.
• Hibernated (viable) myocardium is thought to be the result of chronic ischemia and is generally associated with improvement after revascularization.
• Myocardial viability can be assessed with SPECT perfusion studies (alone or with nitrate stimulation), PET, dobutamine echocardiography, or magnetic resonance imaging, with comparable diagnostic yield.