Cardiology · ⁹⁹ᵐTc-tetrofosmin · Beginner

Atypical chest pain in a 58-year-old man with a BMI of 36

History

58-year-old man, BMI 36 kg/m², with intermittent left-sided chest discomfort at rest and occasionally on exertion. Hypercholesterolaemia; no known coronary disease. Resting ECG normal. Bruce exercise test for 9 minutes, reaching 88% of age-predicted maximum heart rate, with no symptoms or ST change. ⁹⁹ᵐTc-tetrofosmin stress-first protocol; the camera has no CT attenuation correction. Question: is there inducible ischaemia?

Step 1 · Supine stress images

Supine stress ⁹⁹ᵐTc-tetrofosmin SPECT: short-axis and long-axis slices and polar map; arrow on the inferior wall.

The stress images show reduced inferior counts. What is the best next step before deciding on rest imaging?