CCTA effective SPECT alternative for stable chest pain

Coronary CT angiography (CCTA) is an effective alternative to SPECT imaging...Read more on AuntMinnie.comRelated Reading: Machine-learning model predicts adverse cardiac outcomes How helpful is CTA for assessing coronary disease risk? CCTA predicts heart events in stable chest pain patients CCTA can cut complications and hospital stays ESC: CT is effective gatekeeper for invasive angio
Source: Headlines - Category: Radiology Source Type: news

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Introduction: A 73-year-old male patient presented with atypical chest pain radiating to the back of one-week duration. Initial work-up included negative cardiac enzymes, electrocardiogram without signs of ischemia, and a non-contrast-enhanced CT of abdomen and pelvis for concern for renal colic which showed moderate atherosclerotic plaque in the abdominal aorta. The patient underwent an exercise SPECT which showed ST depression in the inferolateral leads with exercise and a small, fixed defect in the apex and inferior region, overall suggestive of intermediate risk for cardiovascular mortality.
Source: Journal of Cardiovascular Computed Tomography - Category: Radiology Authors: Source Type: research
26Objectives: SPECT myocardial blood flow (MBF) imaging can be performed using modern solid state SPECT cameras. It is an additive technique to traditional relative myocardial perfusion imaging (MPI). The additional clinical benefit of MPI remains to be proven and its promise is largely based on prior PET MBF data (1,2,3). We sought to determine whether SPECT MBF would improve the sensitivity of ischemia detection by MPI. Methods: Consecutive patients undergoing clinical SPECT MPI had MBF performed. A comprehensive electronic medical record review was undertaken to determine 12-month cardiovascular follow-up. In patients w...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Myocardial Perfusion and Technical Advances Source Type: research
This 60-something year old male was admitted and his hospital course complicated by GI bleed, hemodynamic instability, and a nadir hemoglobin less than 5 g/dL.  An ECG was relatively normal.The next AM, his potassium was measured at 2.9 mEq/L, so another ECG was recorded.He was asymptomatic.The previous ECG from one week prior had been relatively normal.There are bizarre inverted T-waves and also inverted U-waves (see the 2nd inverted bump?)The QT is incredibly longThere is some subtle STE in inferior leads but also STE in I, aVL.There is STE before the bizarre TU inversion in leads V3-V6.There are some artifacts that...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
DiscussionWhich subacute STEMI should go to the cath lab?Simplified:IF there is subacute STEMI by ECG or other criteria AND:1. Symptoms onset is within 48 hours AND2. There are persistent symptoms OR persistent ST ElevationThen the patient should go for emergent angiogram/PCI.I think it makes sense to extend this beyond 48 hours because ischemia can be so intermittent.Schomig et al. randomized patients with:STEMI12-48 hours of symptomsNo persistent symptomsPersistent ST ElevationNo hemodynamic or electrical instability, no pulmonary edemaThe patients who received emergent PCI had significantly smaller median left ventricul...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath.This ECG was recorded on arrival:What do you think?This is technically a STEMI, with 1.5 mm STE in V1 and 1.5-2.0 mm in V2. The current criteria only require 1mm in V1 and 1.5mm in V2 for a female. However, I think many practitioners might not see this as a clear STEMI, and would instead call this " borderline. " The normal QRS complex with STE and large volume underneath the T-waves in V1-V3 confirm Occlusion MI (OMI). There is not technically STD in V6 and I, how...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
CONCLUSION: The lower cost, higher sensitivity and specificity rates, and faster, less burdensome process for detecting CAD patients make Fast-SENC a more capable and economically beneficial stress test than SPECT. The payer model and hospital model demonstrate an alignment between payer and provider economics as Fast-SENC provides monetary savings for patients and resource benefits for hospitals. PMID: 30732489 [PubMed - as supplied by publisher]
Source: Journal of Medical Economics - Category: Health Management Tags: J Med Econ Source Type: research
AbstractEvaluation of atypical presentation of angina chest pain in emergency department is difficult. Hospitalization of this patient may impose additional costs and waste the time, early discharge may lead to miss the patients. The aim of this study was to determine volubility of Single Photon Emission Computed Tomography (SPECT) in management of patients admitted to emergency department with atypical manifestations of angina pain, un-diagnostic Electrocardiogram (ECG) and negative enzyme. Half of 100 patients admitted to emergency department with atypical chest pain and un-diagnostic ECG who were candidate for admission...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
Rationale: Ventilation/perfusion (V/Q) single-photon-emission computed tomography (SPECT) has arisen as an alternative to computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE) suspicion. The addition of low dose CT (ldCT) to V/Q SPECT improves the specificity of the test, allowing for potential alternative diagnosis. Patient concerns and diagnosis: Here we presented a case of an aortic intramural hematoma (IMH) diagnosed on the ldCT portion of V/Q SPECT combined with CT. A 74-year-old man suffering from sudden-onset chest pain was referred to our nuclear medicine department for PE s...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Written by Pendell Meyers, with edits by Steve SmithA male in his early 40s presented with intermittent chest/abdominal pain. He admitted to several episodes over the past two days, including one episode several hours prior to presentation, described as severe (8/10), substernal " burning, " non-radiating, associated with diaphoresis, described as " feeling food stuck in my throat, " or " like I ate too fast, " but not associated with eating, relieved by belching and flatulence, relieved by lying flat. The episode on the day of presentation was similar except he had the additional new features...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Using coronary CT angiography (CCTA) instead of SPECT myocardial perfusion...Read more on AuntMinnie.comRelated Reading: Stress echo beats CCTA for evaluating chest pain CCTA usage rate rises sharply, but still eclipsed by MPI CCTA predicts heart events in stable chest pain patients PROMISE: CCTA better than functional cardiac testing CCTA can cut complications and hospital stays
Source: Headlines - Category: Radiology Source Type: news
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