Quiz

   The patient is a 57 year old white male who underwent double vessel coronary artery bypass graft surgery 8 years ago. Comorbidities include hypertension and hyperlipidemia. He did well until three months prior to his presentation to the office wit recurrence of his pre-op angina pectoris.
A Tc-99M Sestamibi treadmill stress test was performed. His resting ECG revealed a sinus mechanism with diffuse nondiagnostic low voltage T waves. The resting BP was 170/100 mm Hg. The patient completed six minutes of the Bruce treadmill protocol at a workload of 7 METS and achieved 85% of his maximal predicted heart rate when he developed mild throat tightness which resolved within two minutes of the recovery phase. He had a flat BP response to exercise and the ECG demonstrated shallow T wave inversion in the mid precordial leads with 1 mm ST segment depression in the lateral leads. There were no exercise induced arrhythmias.

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