Acute chest pain imaging in the outpatient setting

Acute SPECT imaging with Tc-99m sestamibi is an emerging, cost-effective stratagem for selected patients arriving at the emergency department with chest pain. To date, the cohort of patients studied have included those who arrive at the emergency department with typical chest pain and a normal or nondiagnostic electrocardiogram. This application could be extended to other clinical settings. The current case demonstrates that in an outpatient setting, a severe rest SPECT perfusion defect in a symptomatic patient with a nondiagnostic electrocardiogram prompted timely hospitalization and revascularization. The resting defect was consistent with jeopardized, viable myocardium as it normalized after revascularization.