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Post-stress Myocardial Stunning Department of Nuclear Medicine

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Post-stress Myocardial Stunning Department of Nuclear Medicine Presentation Transcript

  • 1. Post-stress Myocardial Stunning Department of Nuclear Medicine Seoul Nat’l Univ. College of Medicine Jin Chul Paeng, MD
  • 2. Patient
    • 6-year-old male
    • DOE with cardiac murmur
    • FHx of sudden death (Grandfather and father)
    • Preexam Dx of Idiopathic Hypertrophic Subaortic Stenosis (IHSS)
    • Consulted for myocardial SPECT
  • 3. Protocol STRESS Tc-99m-MIBI Dipyridamole Stress 0.56 mg/kg/4min Gated SPECT 1st 2nd Rest Tc-99m-MIBI Gated SPECT Next day
  • 4.  
  • 5. Surface Motion
  • 6. Stress Wall Thickening Rest Wall Thickening
  • 7. Stress Rest
  • 8. Myocardial Stunning
    • Classic Concept
      • Myocardial dysfunction due to temporary decreased perfusion
      • Dependent on perfusion reserve
    • New Concept
      • Canty JM et al. JNC 2000;7:509-527
      • Two kinds: acute / chronic (repetitive)
      • Preliminary state to ‘hibernation’
      • A different phase on a continuum of coronary artery disease
  • 9. Acute Stunning
    • Induced by acute stress
      • Either physical or psychologic
      • Variable duration
        • Usually prolonged over from several hours to a couple of days
    • How about on iatrogenic stress?
      • Exercise
      • Pharmacoloic
        • Inotropics
        • Vasodilators
  • 10. Prolonged Stunning
    • “ Transient prolonged stunning induced by dipyridamole and shown on 1- and 24-hour poststress 99m Tc-MIBI gated SPECT”
      • Lee DS et al.
      • JNM 2000;41:27-35
      • One-hour poststress myocardial motion shows stunning effect, compared to wall motion at 24-hour after stress
  • 11. Summary
    • Gated myocardial SPECT in patient with IHSS showed decreased motion and thickening at stress image while normal motion and thickening at rest.
    • It can be stunning effect of dipyridalmole stress.