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          Typical chest pain with ECG changes

          Teaching Case

          Case presentation:

          • Male.
          • 58 y.o.
          • Diabetic.
          • Smoker.
          • Hypertension (poorly controlled).
          • Admitted for episode of chest pain 72 hs ago (resolved).
          • ECG: Inferior Q waves, dynamic changes lateral wall.
          • Echo: Mild LVH, inferior hypokinesis, LVEF ~40%.
          • Myocardial perfusion with dipyridamole requested.

          Teaching points:

          • In patients with no known coronary artery disease, MPS adds prognostic information and risk-stratifies patients beyond clinical data.
          • Semiquantitative information obtained by MPS provides important measurements of disease extent and severity, however visual analysis is able to depict high-risk patients in most cases.
          • In patients with 3-vessel disease, perfusion defects can be restricted to only one or two arterial territories, because due to the fundamentals on which nuclear images are based, the region with relative ‘best perfusion’ can appear ‘normal’ (like the lateral wall in this particular case, despite a lesion in the Cx artery).

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