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MCQ 46. Cardiac investigations

Q. A 60-year-old man with no previous symptoms had a routine ECG. The ECG shows left bundle branch block. The patient is currently taking Aspirin 75 mg od. He has a family history of myocardial infarction. He smokes 20 cigarettes a day. The GP is concerned and refers the patient for further investigation. On examination, BP is 120/70 mmHg and there are no findings during cardiovascular examination. Which of the following investigations is indicated?
A. Exercise ECG
B. CT of coronary arteries
C. Myocardial perfusion imaging
D. Coronary angiography  

 Answer: C. Myocardial perfusion imaging

 Explanation:

 For a patient with moderate likelihood of CAD (this patient is not symptomatic so is not in the high-risk category) non-invasive testing such as
Exercise tolerance tests or myocardial perfusion tests should be performed.
An exercise ECG test (TMT) will be difficult to interpret in this case due to the ECG changes of LBBB. Thus its most appropriate to conduct a myocardial perfusion scan. 
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