Prominent Right Ventricular Tracer Uptake: A Harbinger of Multivessel Coronary Artery Disease

A 65-y-old woman with multiple cardiovascular risk factors presented with atypical chest pain, prompting a 1-d pharmacologic stress myocardial perfusion test using ^99mTc sestamibi. Initial interpretation suggested ischemia, but closer inspection revealed increased right ventricular uptake and increased left ventricular chamber size at stress, indicative of significant 3-vessel coronary artery disease (CAD). These findings were confirmed by cardiac catheterization, showing 3-vessel disease, including significant left main CAD. The patient underwent coronary artery bypass graft surgery. This case highlights the importance of meticulous SPECT image interpretation, particularly focusing on right ventricular uptake and transient ischemic dilation, to accurately diagnose severe CAD and improve cardiovascular outcomes.