Uncertainty of Myocardial Perfusion Imaging in Chest Pain Risk Stratification

Background: Chest pain is a common presenting symptom in the emergency department (ED). Although the diagnostic workup for chest pain is well established, the best time to perform invasive cardiac catheterization in patients with low to moderate risk of coronary artery disease is still unclear, particularly if noninvasive tests such as the electrocardiogram (ECG) and nuclear myocardial perfusion scan show nonsignificant findings. Case Report: We present the case of a 52-year-old female who presented to the ED with acute-onset chest pain that had started early in the morning while she was sleeping. She had presented to the ED 2 weeks prior with chest pain, but her ECG and transthoracic echocardiogram were normal, and her myocardial perfusion scan revealed no significant perfusion defect, so she was discharged. During her second ED visit, the patient developed an arrhythmia, diagnosed as supraventricular tachycardia, that was rapidly converted to sinus rhythm with one dose of intravenous adenosine. Because ...