72 year-old male patient was prior history of catheter based closure of ASD/PFO. Now presents with chest discomfort.
4 minutes 6 seconds on a Bruce protocol with typical anginal chest pain and 1 mm of horizontal ST segment depression during exercise with a further 0.5 mm ST segment depression in recovery.
Severe perfusion abnormality involving the anteroapical and anteroseptal walls with mild stress induced Left Ventricular cavity dilation. The perfusion defect reversed completely at rest. Resting left ventricle ejection fraction 75% falling to 56% at peak exercise.
Significant LAD stenosis at two levels and totally occluded right coronary artery. LAD disease treated with stenting.