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          Asthmathic, atypical chest pain.Chronic LBBB

          Teaching Case

          Case presentations:

          • Female.
          • 66 y.o.
          • No known risk factors for CAD.
          • Asthmathic, atypical chest pain.
          • Chronic LBBB. -Had bronchospasm when submitted for MPS with dipyridamole, so she was switched to exercise.

          Teaching points:

          • Regadenoson is a pharmacologic agent approved by the FDA in 2008 as an agent for use in stress testing and can also be used in combined protocols with exercise.
          • Regadenoson produces maximal hyperemia quickly after IV injection as a bolus and maintains it for an optimal duration, practical for myocardial perfusion imaging.
          • Regadenoson is an agonist with low affinity for the A2A adenosine receptor, and at least a 10-fold lower affinity for the A1 adenosine receptor. In addition, it has relatively weak affinity for the A2B and A3 adenosine receptors.
          • Coronary vasodilation and an increase in coronary blood flow (CBF) results from activation of the A2A adenosine receptor by regadenoson.

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