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Ischaemia : Abnormal Example

Patient Description

  • 55 yr old man referred for investigation of chest pain. Smoker, BP
  • Dobutamine stress & myocardial contrast echocardiography performed
  • Normal wall motion (and therefore by definition perfusion) at rest


Abormal Example - STRESS

AP4C AP2C AP3C
Note:
  • At peak stress, widespread perfusion defects in all apical segments, septum and anterior wall despite only the apical septum being hypokinetic.

 

Freeze frames showing perfusion defects

AP4C AP2C AP3C
Note:
  • These are still frames from 1 second after flash destruction. Note the heart rate of 122-126bpm. The yellow arrows depict clear perfusion defects in all three apical views.

 

Abormal Example - Angiogram

Note:
  • Thus by wall motion criteria, there was only 1/17 ischaemic segments (apical septum)
  • But by perfusion, there were 6/17 ischaemic segments (true apical cap, apical septum, apical lateral, apical inferior, apical anterior and mid anterior)
  • Coronary angiography revealed an entirely occluded LAD coronary artery, thus proving the incremental value of MCE over wall motion in this case