Stress Testing/
Nuclear Cardiology
Cardiac Catheterization/
Interventional Cardiology
Arrhythmia Service
(Coumadin) Clinic


Inferolateral Ischemia

The patient is a 63 year old male with a known history for coronary artery disease
who was referred for stress thallium due to chest pain.
He exercised for 12 minutes and had no chest pain. His peak heart rate was 142 BPM
( < 85% of his predicted maximal HR). There was 3 mm horizontal ST depression in
leads V3-5.
The thallium scan above shows a moderate inferolateral defect with significant
redistribution in the rest scans, consistent with moderate inferolateral ischemia.
At cardiac catheterization, he had 100% occlusion of the left circumflex coronary
artery with collateral flow from the circumflex and LAD territories. The likely
reason for ischemia (as opposed to myocardial infarction with a 100%
occluded artery) is that collateral circulation cannot meet the increased
myocardial demand during exercise.