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(Circulation. 1999;99:589-590.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Reactive Hyperemia After Release of Coronary Spasm

Hiroki Sugihara, MD; Noriyuki Kinoshita, MD; Yoshihiko Adachi, MD; Masayuki Hyogo, MD; Akihiro Azuma, MD; Masao Nakagawa, MD

From Kyoto Prefectural University of Medicine, Department of Radiology (H.S.) and Second Department of Medicine (N.K., Y.A., M.H., A.A., M.N.), Japan.

Correspondence to Hiroki Sugihara, MD, Department of Radiology, Kyoto Prefectural University of Medicine, Kajii-cyo, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-0841, Japan.

Exercise stress perfusion imaging was performed in a 55-year-old man suspected of having angina pectoris. During mild exercise, he had chest pain, and an ECG showed ST-segment elevation in leads aVL and V₁ through V₄. Then, 370 MBq of ^99mTc-tetrofosmin was injected intravenously, and 1 minute after injection, 0.3 mg of nitroglycerin was administered sublingually twice. ²⁰¹Tl 111 MBq was injected intravenously immediately after disappearance of chest symptoms and ST-segment elevation (5 minutes after ^99mTc-tetrofosmin injection). Dual single photon emission computed tomographic (SPECT) images were obtained 30 minutes after injection of ^99mTc-tetrofosmin. Myocardial per-fusion images with ^99mTc-tetrofosmin showed defects in the anterior, apical, and septal segments related to exercise-induced vasospasm of the left anterior descending coronary artery (LAD). Myocardial perfusion images with ²⁰¹Tl showed high uptake in the same regions as shown in ^99mTc-tetrofosmin images (Figure 1). ²⁰¹Tl images disclosed an increase in blood flow in the LAD by reactive hyperemia after release of transient coronary spasm. A coronary arteriogram revealed spasm of the LAD and its disappearance after administration of nitroglycerin. Two weeks after medication with diltiazem and a long-acting nitrate, exercise myocardial perfusion images with ²⁰¹Tl showed even distribution of the tracer in the left ventricle.

View larger version (50K): [in this window] [in a new window]   Figure 1. 99mTc-tetrofosmin and 201Tl images: 99mTc-tetrofosmin images showed defects in the anterior and apical segments consequent to spasm of the LAD (top). 201Tl images showed high uptake in the same regions by reactive hyperemia (bottom).

View larger version (13K): [in this window] [in a new window]   Figure 2. Imaging protocol: 99mTc-tetrofosmin was injected during chest pain and ST-segment elevation, and 201Tl was injected immediately after sublingual administration of nitroglycerin.

View larger version (90K): [in this window] [in a new window]   Figure 3. ECG during exercise showed ST-segment elevation in leads aVL and V1 through V4.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sugihara, H. Articles by Nakagawa, M. Search for Related Content PubMed PubMed Citation Articles by Sugihara, H. Articles by Nakagawa, M. Pubmed/NCBI databases Substance via MeSH Related Collections Exercise testing Coronary imaging: angiography/ultrasound/Doppler/CC