Pitfalls and bugs of nuclear and CT cardiac scans in an extremely obese patient: reasons for using conventional coronary angiography as first-line test

In October 2012, an asymptomatic 54-year-old man, with a body mass index (BMI) of 50 kg/m2, smoking habits, hypertension, dyslipidaemia and family history of coronary artery disease (CAD) presented to us for a clinical work out. Since these conditions indicate high risk of CAD,1 he underwent exercise/rest sestamibi gated single-photon-emission cardiac tomography (G-SPECT). This procedure documented submaximal exercise test and inconclusive anterior wall perfusion defect. A reduced exercise capacity and tissue attenuation characterise obesity and determine doubtful SPECT results (figure 1). A 64-slice cardiac tomography (CT) detected calcium deposits over the anterior descending (LAD) and first diagonal (D1) coronary …