Learning Resources
Clinical Cases
Cardiac Cases
Case 1: Inferior Ischemia

Case 1: Inferior Ischemia

Clinical History

Patient: 65-year-old male Presentation: Recurrent exertional chest pain Risk Factors: Hypertension, Hyperlipidemia, Former smoker Referral: Assessment of ischemia

Imaging Findings

Technique: One-day Rest/Stress Tc-99m Sestamibi SPECT/CT

Perfusion Images

The myocardial perfusion polar map (bullseye plot) demonstrates:

  • Stress: Moderate intensity defect involving the inferior and inferolateral walls (basal and mid segments).
  • Rest: Significant improvement/normalization of the perfusion in the corresponding segments.
  • Gating: Normal LV cavity size with normal wall motion and thickening. Calculated LVEF = 62%.

Cardiac Polar Map showing inferior ischemia

Diagnosis

Key Findings:

  • Reversible perfusion defect in the inferior/inferolateral wall.
  • Preserved wall motion and thickening.

Interpretation: Indicates ischemia in the distribution of the Right Coronary Artery (RCA).

Learning Points

  1. Reversibility: The hallmark of ischemia is a defect that is present at stress but improves or resolves at rest.
  2. Key Vascular Territories:
    • LAD: Anterior wall, septum, apex
    • RCA: Inferior wall, basal septum
    • LCx: Lateral wall
  3. Prognostic Value: The extent and severity of ischemia (Summed Difference Score) correlates with future cardiac event risk.