THE SIGNIFICANCE OF TRANSIENT ISCHEMIC DILATION IN MYOCARDIAL PERFUSION IMAGING IN A PATIENT WITHOUT A FIXED OR REVERSIBLE DEFECT

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coronary artery disease (CAD) has high prevalence with the American Heart Association (AHA) reporting 15.5 million people in USA affected 2016. The presentation vary from asymptomatic to severe symptoms relating ischemia such as chest pain, dyspnea, and hemodynamic instability. Some populations require important attention their is not always classic. These include elderly women. In this report, we present an unusual of coronary finding on myocardial perfusion imaging (MPI). CASE PRESENTATION: An 81 year old male past medical history significant for CAD previous stenting RCA, hypertension who presented numbness left arm side face. have resolved before arrival ED. Patient was diagnosed transient ischemic attack (TIA).TIA work up revealed stenosis right internal carotid. Part TIA work, EKG serial troponins were obtained patient complained intermittent pain at home. All tests negative any sign ischemia. Telemetry did detect abnormalities. ECHO also done showed EF 50-55% normal LV wall motion. vascular surgery team consulted per neurology service request. They requested further cardiac stratification determine appropriate surgical intervention. MPI a dilation without fixed or reversible defect. However, given overall clinical picture presentation, decision elective heart catheterization made. 80% lesion proximal mid LAD then stent placed. discharged home dual anti-platelet therapy (DAPT) goal directed therapy. DISCUSSION: Transient one findings reported that can indicate obstructive pattern. pose dilemma it occur even when flow scan normal. pathophysiology phenomena well understood. fact, been its sensitivity specificity 44% 88%, respectively detecting extensive anatomic CAD. That why clinicians recognize significance overlook it. CONCLUSIONS: Ignoring may lead catastrophic devastating event patients if carefully assessed. diagnostic value be coupled picture. REFERENCE #1: Sanchis-Gomar, Fabian, et al. "Epidemiology Acute Syndrome." Annals Translational Medicine, AME Publishing Company, July #2: JR;, Dvorak RA;Brown RK;Corbett. "Interpretation SPECT/CT Myocardial Perfusion Images: Common Artifacts Quality Control Techniques." Radiographics : ReviewPublication Radiological Society North America, Inc, U.S. National Library Medicine #3: Alama, Mohamed, "Diagnostic Prognostic Significance IschemicDilation (TID) Imaging: A Systematic Review Meta-Analysis." Journal Nuclear Cardiology Official Publication Cardiology, Springer US, June 2018 DISCLOSURES: No relevant relationships by Mohamed Abdelhabib, source=Web Response Rajan Gaur, Zachary Morrison, Gabriel Ruiz, Wilson, no disclosure file Siamac Yazdchi