Question 23#
A 56-year-old male smoker with a family history significant for CAD is presenting with dyspnea on exertion and nonexertional vague chest pain. His physical examination and his initial ECG are unremarkable. His CXR demonstrates an increased cardiac silhouette. There is also a small nodule seen in his right upper lobe. The radiologist is not certain about its significance. Given his risk factors and symptoms, he is referred for a perfusion stress test. The images from the stress test are shown in Figure below.
Which of the following does the patient clearly have?
A. He has coronary ischemia and should be referred for coronary angiographyB. There is no evidence of pathology to justify his symptoms
C. His symptoms are related to impairment of RV filling and pericardial disease
D. He has mild ischemia and can be treated medically
Correct Answer is C
Comment:
His symptoms are related to impairment of RV filling and pericardial disease. This patient with the main presentation of dyspnea has an increased cardiac silhouette. The nuclear image provided shows a circumferential echolucency surrounding the heart. This is consistent with a large pericardial effusion, and he most likely has RA and RV diastolic compromise. There is no evidence of a perfusion defect to suggest ischemia.