Triple vessel coronary artery disease presenting as a markedly positive stress electrocardiographic test and a negative SPECT-TL scintigram: a case of balanced ischemia
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.
False negative stress testing, balanced ischemia.
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
Share this Article
Related Content In Imaging
The Evolving Role of Echocardiography During the Coronavirus Disease 2019 Pandemic
Heart International. 2022;16(1):28–36 DOI: https://doi.org/10.17925/HI.2022.16.1.28
As of the publication of this article, the coronavirus disease 2019 (COVID-19) infection has affected over 400 million people around the world and caused over 6 million deaths.1 Although COVID-19 infection predominantly affects the respiratory system, studies have described a wide spectrum of cardiovascular manifestations, including asymptomatic myocardial injury, myocardial infarction and myocarditis.2 Echocardiography is an easily […]
The Quantification of Total Coronary Atheroma Burden – A Major Step Forward
Heart International. 2020;14(2):73-5 DOI: https://doi.org/10.17925/HI.2020.14.2.73
More than half of acute coronary syndromes (ACS) occur in subjects with no significant coronary stenosis.1 In view of the number of patients dying each year from a heart attack, the question of identifying these patients is of primary importance. A large body of evidence currently exists, indicating that total coronary atheroma burden (TOCAB) – the […]
Left main Stenosis Stenting Normalizes Wall Shear Stress of Ascending Aorta in Bicuspid Aortic Valve
Heart International. 2020;14(2):121-2 DOI: https://doi.org/10.17925/HI.2020.14.2.121
Bicuspid aortic valve (BAV) represents the most common congenital cardiac anomaly, with a prevalence ranging between 1% and 2% in the general population.1 BAV is known to be associated with dilation and dissection of the ascending aorta, and the significantly higher shear forces seem to have a pivotal role on the development of such complications.2 Nowadays, patients […]
Journal articles and more to your inbox
Get the latest clinical insights from touchCARDIOSign me up!