Case presentation:

• Male.
• 41 y.o.
• Overweight, hypertension, high cholesterol, stress.
• Typical chest pain.
• Echocardiogram: mild LVH, normal LV function.
• Exercise test: chest pain witn no ECG changes.
• Myocardial perfusion study (MPS) with exerecise.

Teaching points:

• In patients with no known coronary artery disease and at overall low-tointermediate risk, myocardial perfusion SPECT adds prognostic information and risk-stratifies patients beyond clinical and exercise data.
• Semiquantitative information obtained by gated SPECT provides important measurements of disease extent and severity.
• Perfusion scores are useful tools in clinical decision making and have been shown to have independent risk-stratification value.
• Post-ischemic stunning, as assessed by gated SPECT, is a marker for poor prognosis, particularly for ischemic cardiac events.
• Patients with high risk results should be managed aggressively - with revascularization procedures if possible.