MYOCARDIAL SPECT PERFUSION STUDY:  RESTING AND PHARMACOLOGIC STRESS Tc99m TETROFOSMIN (MYOVIEW)

DATE: 1/9/2006

PROCEDURE: After injection of technetium 99m tetrofosmin (Myoview), resting SPECT images of the heart were acquired.  Subsequently, 99mTc tetrofosmin (Myoview) was injected at peak stress and gated SPECT images of the heart were obtained.

Mode of Stress:  Dobutamine [25] mg 

DOSE:  99m Tc tetrofosmin (Myoview) Rest: [8] mCi, Stress: [25] mCi

COMPARISON: None

CLINICAL HISTORY:  The patient is a [...]-year-old female with [...]. Now referred to Nuclear Medicine for evaluation of possible stress induced ischemia.

FINDINGS:

EKG Rest: Normal sinus rhythm. No Q waves, T wave inversions, or ST segment changes. 
 
EKG Stress: No ischemic ST segment changes.

STRESS RESPONSE:  

Heart Rate at Rest: [...] bpm

Heart Rate at Peak Stress: [...] bpm  

Blood Pressure at Rest: [...] mmHg

Blood Pressure at Peak Stress: [...] mmHg

Symptoms: Mild palpitation that resolved 1-2 minutes post dobutamine infusion.

MYOCARDIAL PERFUSION STUDY:

Left ventricular chamber size: Normal.

PERFUSION WITH STRESS: Normal perfusion to all walls of the left ventricular myocardium. Mild decrease in tracer activity in the proximal to mid inferior wall. Mild decrease in tracer activity in the distal anteroseptal wall. Normal perfusion to the rest of the left ventricular myocardium. Normal perfusion to all walls of the left ventricular myocardium.  Moderate to severely decreased tracer activity in the proximal to distal inferior wall extending into the inferoapical region. Homogeneous normal activity in the remainder of the left ventricular myocardium.

PERFUSION AT REST: Unchanged from perfusion with stress. The fixed defect of the inferior wall is most likely due to diaphragmatic attenuation. The fixed defect of the distal anteroseptal wall is most likely due to breast attenuation. 
 
Gated study 15-20 minutes post stress: Normal motion and wall thickening. Mild septal hypokinesis consistent with the patient's history of CABG.

Estimated left ventricular ejection fraction: [...]%.

Comparison with the previous myocardial perfusion scan [dated ...] indicates that there has been no significant interval change.

CONCLUSIONS: 

1. Normal study with no scintigraphic evidence for stress induced ischemia or prior myocardial infarction.

2. The left ventricle is of normal size and demonstrates normal wall motion with an estimated ejection fraction of [...]%.

1. Fixed perfusion defect in the inferior wall extending into the apex which is consistent with prior infarction in the RCA territory. There is no evidence for stress induced ischemia.

2. Wall motion abnormalities as noted above. Estimated left ventricular ejection fraction is [...]%.

3. No significant interval change compared to the previous myocardial perfusion scan of [...].

Thank you for referring this patient to the UCLA Nuclear Medicine Clinic.

I, [...], M.D., Ph.D., have reviewed this Nuclear Medicine study personally, and am in full agreement with the findings of the report presented here.