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Atherosclerosis, Imaging
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Triple vessel coronary artery disease presenting as a markedly positive stress electrocardiographic test and a negative SPECT-TL scintigram: a case of balanced ischemia

Published Online: August 7th 2018 Heart International 2011;6(2):e22
Authors: Emad F. Aziz, Fahad Javed, Carlos L. Alviar, Eyal Herzog
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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.

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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

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2011-05-18T00:00:00

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