Multi Vessel Coronary Artery Disease Presenting as a False Negative Myocardial Perfusion Imaging and True Positive Exercise Tolerance Test : A Case of Balanced Ischemia
Copyright © 2020, Baqi et al..
Non-invasive investigations play an important role in the early diagnosis of coronary artery disease. Although the stress test is an easily available investigation for the diagnosis of obstructive coronary artery disease, its results are affected by the pretest probability. Myocardial perfusion imaging (MPI) is one of the commonly performed non-invasive cardiac imaging. The common reasons for false-negative exercise MPI are reported to be inadequate exercise, a lower dose of radio-tracer, small area of perfusion defect, and ischemia caused by left circumflex or its branches. Balanced ischemia is one of the rare causes of false-negative MPI. In this case report, we present a 73-year-old gentleman who presented with chest pain and shortness of breath. An exercise electrocardiogram (ECG) at five metabolic equivalents was positive for symptoms and electrocardiographic evidence of ischemia, but the myocardial perfusion image did not show ischemia. An invasive coronary angiogram was done due to high-risk exercise ECG, which revealed severe three-vessel coronary artery disease. Although the false-negative myocardial perfusion scan in the presence of a positive exercise electrocardiogram is unusual, it should not be ignored. Positive exercise ECG with the reproduction of symptoms indicates a high probability of critical coronary artery disease, irrespective of perfusion defects.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
|---|---|
| Enthalten in: |
Cureus - 12(2020), 11 vom: 04. Nov., Seite e11321 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Baqi, Abdul [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Balanced ischemia |
|---|
| Anmerkungen: |
Date Revised 08.12.2020 published: Electronic Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.7759/cureus.11321 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM318484730 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM318484730 | ||
| 003 | DE-627 | ||
| 005 | 20231225165440.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.7759/cureus.11321 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1061.xml |
| 035 | |a (DE-627)NLM318484730 | ||
| 035 | |a (NLM)33282595 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Baqi, Abdul |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Multi Vessel Coronary Artery Disease Presenting as a False Negative Myocardial Perfusion Imaging and True Positive Exercise Tolerance Test |b A Case of Balanced Ischemia |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 08.12.2020 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright © 2020, Baqi et al. | ||
| 520 | |a Non-invasive investigations play an important role in the early diagnosis of coronary artery disease. Although the stress test is an easily available investigation for the diagnosis of obstructive coronary artery disease, its results are affected by the pretest probability. Myocardial perfusion imaging (MPI) is one of the commonly performed non-invasive cardiac imaging. The common reasons for false-negative exercise MPI are reported to be inadequate exercise, a lower dose of radio-tracer, small area of perfusion defect, and ischemia caused by left circumflex or its branches. Balanced ischemia is one of the rare causes of false-negative MPI. In this case report, we present a 73-year-old gentleman who presented with chest pain and shortness of breath. An exercise electrocardiogram (ECG) at five metabolic equivalents was positive for symptoms and electrocardiographic evidence of ischemia, but the myocardial perfusion image did not show ischemia. An invasive coronary angiogram was done due to high-risk exercise ECG, which revealed severe three-vessel coronary artery disease. Although the false-negative myocardial perfusion scan in the presence of a positive exercise electrocardiogram is unusual, it should not be ignored. Positive exercise ECG with the reproduction of symptoms indicates a high probability of critical coronary artery disease, irrespective of perfusion defects | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a balanced ischemia | |
| 650 | 4 | |a exercise tolerance test | |
| 650 | 4 | |a myocardial perfusion imaging | |
| 700 | 1 | |a Ahmed, Intisar |e verfasserin |4 aut | |
| 700 | 1 | |a Nagher, Babar |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Cureus |d 2013 |g 12(2020), 11 vom: 04. Nov., Seite e11321 |w (DE-627)NLM24118083X |x 2168-8184 |7 nnns |
| 773 | 1 | 8 | |g volume:12 |g year:2020 |g number:11 |g day:04 |g month:11 |g pages:e11321 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.7759/cureus.11321 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 12 |j 2020 |e 11 |b 04 |c 11 |h e11321 | ||