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Figure 2 Exercise stress/rest Tc-99m gated single photon emission computed tomography images of a 59-year-old male with without prior known coronary artery disease, who presented with new onset exertional angina and dyspnea. He exercised to 7 metabolic equivalents, heart rate 105, and systolic blood pressure of 209 mm Hg. He developed chest pain and nondiagnostic electrocardiogram changes. Perfusion images revealed a partially reversible defect in a single vascular territory (inferior). Combined perfusion and functional images revealed abnormal thickening in multiple vascular territories (asterisks reflect abnormal thickening fractions in anterior and inferolateral territories) and global reduced left ventricular ejection fraction (47%). Coronary angiography performed after the stress test revealed 75% left main, 90% proximal left anterior descending coronary artery, and 100% right coronary artery stenoses.