October 2010 through a generous grant provided by WAWA. Goal has been to identify and risk stratify female patients at risk for heart disease in an effort to manage and minimize their risk as a part of primary prevention of heart disease. The goal is to also identify and treat heart disease early to prevent any future cardiac events in our female patients. Many female patients have been treated and managed in our center. Very diverse group of patients from as young as 22 yrs. of age to as old as 89 yrs. of age.

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Cardiac Imaging is vital in the accurate and timely diagnosis of heart disease in the female patient. Cardiac imaging determines time of intervention for may cardiac disease and determine treatment strategy.

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ARTIFACTS AND PITFALLS DURING NUCLEAR STRESS TESTING- CASE PRESENTATIONS FROM OUR LAB Renee Bullock-Palmer, MD FACC FASNC FASE Director of Non-Invasive Cardiac Imaging,

Deborah Heart and Lung Hospital Center

DISCLOSURES

None

CASE 1

45 y/o female with history of Hyperlipidemia, Hypertrophic Cardiomyopathy, Osteoarthritis and ex-tobacco smoker presented for Nuclear stress testing with Regadenoson due to chest pain with abnormal EKG.

RESTING EKG

STRESS TESTING

Patient had no angina with regadenoson, BP and Heart rate response were unremarkable. EKG portion was non diagnostic due to baseline ST-T abnormalites

NUCLEAR STRESS RAW DATA

NUCLEAR STRESS SPECT IMAGES

NUCLEAR STRESS GATED IMAGES

CARDIAC CATHETERIZATION

Angiographically normal coronaries Right coronary dominant circulation LVOT gradient of 27 mmHg with provocation.

TEACHING POINTS Increased radiotracer uptake in the hypertrophied septal wall in Hypertrophic cardiomyopathy resulting in a normalization artifact and resulting perception that there is extensive ischemia in the anterior, lateral, inferior walls as was the case in this patient.

CASE 2

88 y/o female with history of cardiomyopathy with LVEF 10%, deconditioning, CVA and h/o ICD-CRT placement, referred for stress testing due to chest pain.

RESTING EKG

STRESS TESTING

Patient had no angina with regadenoson, BP and Heart rate response were unremarkable. EKG portion was non-diagnostic.

NUCLEAR STRESS RAW DATA

NUCLEAR STRESS SPECT IMAGES

NUCLEAR STRESS GATED IMAGES

CARDIAC CATHETERIZATION

Minor luminal irregularities of the left main, LAD, LCx as well as RCA. Dominant coronary circulation.

TEACHING POINTS

In some patients, nuclear stress image acquisition has to be performed with the left arm down due to recent device (pacemaker, ICD) placement or due to presence of hemiparesis from prior CVA. Differential positioning of the left arm in these cases may cause a perceived reversible perfusion defect. It is therefore very important during acquisition that the left arm positioning is equal on rest as well as stress images.

NUCLEAR STRESS RAW DATA