Triple vessel coronary artery disease presenting as a markedly positive stress electrocardiographic test and a negative SPECT-TL scintigram: a case of balanced ischemia
Abstract
Overview
The presence of false negative nuclear
stress test in the settings of positive electrocardiographic
changes is a very unusual phenomenon
and is usually secondary to balanced
ischemia of the myocardial segments evaluated
by SPECT-TL. We present a case of an 81-
year old post-menopausal female who presented
to her primary care physician for evaluation
of a 6-week dyspnea on exertion and was
referred to our institution for exercise stress
test with Thallium SPECT with the objective of
ruling out coronary artery disease and identifying
possible areas of myocardial ischemia.
The resting electrocardiogram was unremarkable
and stress test evaluation was made. The
patient was admitted to the cardiac care unit
and coronary artery bypass grafting was successfully
performed. The presence of false
negative nuclear stress test in the settings of
positive electrocardiographic changes is a very
unusual phenomenon and is usually secondary
to balanced ischemia of the myocardial
segments evaluated by SPECT-TL. Patients
undergoing stress tests with these characteristics
should undergo careful evaluation and a
high level of suspicion should be adopted for
further diagnostic assessment of coronary
artery disease.
Keywords
False negative stress testing, balanced ischemia.
Article Information
Correspondence
Emad F. Aziz, Coordinator ACAP Program, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA. E-mail: DrEAziz@Gmail.com; Eaziz@NYIT.Edu
Received
2011-05-18T00:00:00
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