Case of the Month: March 2013

Submitted by Sean Welsh, MD, and Thomas J. Learch, MD 


  • 45-year-old male presents to the emergency department with crushing, substernal chest pain x 2 hours. He is short of breath and diaphoretic. His vital signs are labile. On examination he is disoriented to time and place, tachypneic, with rales at the bases. Social history is remarkable for cocaine abuse.
  • Stat labs were ordered, and an acute coronary syndrome was suspected.
  • The patient was sent for myocardial perfusion imaging for further evaluation.

For full-size images please click on Myocardial Perfusion 1 and Myocardial Perfusion 2 .


What is the salient finding on this resting myocardial perfusion examination?

A. Large resting defect in the left anterior descending coronary distribution
B. Large resting defect in the circumflex distribution
C. Large resting defect in the right coronary distribution
D. Large resting defects in the left anterior descending and right coronary distributions


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