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Cardiology Options for Patient With History of Heart Disease

A 55-year-old female presents with an extended history of heart disease. Using thallim scintigraphy, a large and nonreversible anterior septal segment defect was found. Because the myocardium was determined to be nonviable, the woman was to be evaluated for a cardiac transplant. 

Upon a visit to a different cardiologist for a second opinion, a FDG PET was ordered. This test revealed that the myocardium demonstrated good viability throughout most of it. There was a small region of the apex. 

Should treatment change for the patient? Based on the original results of the single photon nuclear medicine study, her cardiologist believed she should be placed on the transplant list. With the new information regarding the myocardium now available, should her treatment be changed? If so, what are her options? 

  • pt should have repeat cardiac cath. multiple multiple areas of viability on PET may suggest 3 vessel disease that could create false negative nuclear test. If CAD is nonintervenable or not bypassable consider transplant eval. if pt meets these criteria
    December 22, 2019
  • No transplant committee in their right mind would use an organ when the patient probably is re-vascularizable. PET is far superior to Thallium to viability; Thallium normalizes to the hottest pixel, whereas PET shows the real truth. I agree with Dr. Cerel above that she probably has balanced ischemia and/or left main disease. Out of curiosity, given the large nonreversible defect on nuclear, does she happen to have large breasts that may have caused an artifact?
    January 21, 2020