Indications for Nuclear Myocardial Perfusion Imaging (MPI):
Exercise MPI:
- Intermediate-high risk, able to exercise, with uninterpretable ECG (class I) or interpretable ECG (class IIa)
- Known SIHD, able to exercise, new symptoms
- Contraindications to Exercise MPI:
- Low-risk & able to exercise –> instead do Exercise ECG
- Routine LV function if no new signs/symptoms
- No changes < 5 yr after ACB surgery or < 2 yr after PCI
- Essentially asymptomatic patients
Pharmacological MPI:
- Intermediate-high risk and unable to exercise
- Left Bundle Branch Block (LBBB) regardless of exercise
- Known SIHD, unable to exercise or LBBB, new symptoms
- Contraindications to Pharma MPI:
- Low-risk & able to exercise –> instead do an Exercise ECG
- Intermediate-high risk, able to exercise, interpretable ECG –> instead do exercise ECG or MPI
- Routine LV function if no new signs/symptoms
- No changes < 5 yr after ACB surgery or < 2 yr after PCI
- Essentially asymptomatic patients
Uninterpretable ECG, remember the mnemonic PELViS:
- P: pre-excitation (WPW)
- E: excess of > 1 mm ST depression
- L: left bundle branch block (LBBB)
- V: ventricular pacing
- i
- S: ST/T changes from LVH or digoxin for example
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