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    Asthmathic, atypical chest pain.Chronic LBBB

    Teaching Case

    Case presentations:

    • Female.
    • 66 y.o.
    • No known risk factors for CAD.
    • Asthmathic, atypical chest pain.
    • Chronic LBBB. -Had bronchospasm when submitted for MPS with dipyridamole, so she was switched to exercise.

    Teaching points:

    • Regadenoson is a pharmacologic agent approved by the FDA in 2008 as an agent for use in stress testing and can also be used in combined protocols with exercise.
    • Regadenoson produces maximal hyperemia quickly after IV injection as a bolus and maintains it for an optimal duration, practical for myocardial perfusion imaging.
    • Regadenoson is an agonist with low affinity for the A2A adenosine receptor, and at least a 10-fold lower affinity for the A1 adenosine receptor. In addition, it has relatively weak affinity for the A2B and A3 adenosine receptors.
    • Coronary vasodilation and an increase in coronary blood flow (CBF) results from activation of the A2A adenosine receptor by regadenoson.

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