Impression:
Mild reduced uptake in the inferior wall at rest (arrows) and moderate-to-severe transient changes (small lines) -- consistent with nontransmural MI (6/25 segments) and moderate-to-severe ischemia in the residual myocardium (5/25 segments) (RCA territory).
Extracardiac activity (liver) (green arrows with "L") is visible in the short axis in the rest study. It does not adversely affect the image quality.
Coronary angiography:
RCA - 90% stenosis in the middle portion
LAD and LCX - no significant change
Comment:
Silent MI and silent stress-induced ischemia is not uncommon, and equally common in patients with and without DM.
Silent ischemia may increase risk of sudden death.
