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Journal of Nuclear Cardiology

, Volume 25, Issue 6, pp 2186–2188 | Cite as

Exercise-induced ST elevation with minimal ischemia by perfusion imaging

  • Ayman A. Farag
  • Shane Prejean
  • Ami E. Iskandrian
  • Fadi G. Hage
Images that Teach

Case Presentation

A 66-year-old African-American man with history of hypertension, hyperlipidemia, pulmonary embolism, tobacco use, and cocaine abuse over a year ago presented with resting chest pain that lasted 15 minutes and recurred after 45 minutes. The pain was sharp, left sided, and radiated to the left arm but without dyspnea, diaphoresis, or palpitations. The pain resolved spontaneously without intervention upon his arrival to the emergency department.

His medications included atorvastatin, spironolactone, and warfarin. The physical examination was normal. The electrocardiogram and serial serum troponin levels were normal.

He underwent exercise SPECT myocardial perfusion imaging (MPI) on the following day using stress/rest protocol (Table  1). He exercised for 3:26 minutes and was asymptomatic during exercise but developed ST elevation during the first stage of Bruce protocol. The exercise was terminated and he complained of chest tightness during recovery requiring 3...

Notes

Disclosure

All authors declare that they have no conflict of interest.

References

  1. 1.
    Bajaj NS, Singh S, Farag A, El-Hajj S, Heo J, Iskandrian AE, Hage FG. The prognostic value of non-perfusion variables obtained during vasodilator stress myocardial perfusion imaging. J Nucl Cardiol 2016;23:390-413.CrossRefGoogle Scholar
  2. 2.
    Fuller CM, Raizner AE, Chahine RA, et al. Exercise-induced coronary arterial spasm: Angiographic demonstration, documentation of ischemia by myocardial scintigraphy and results of pharmacologic intervention. Am J Cardiol 1980;46:500-6.CrossRefGoogle Scholar
  3. 3.
    Chaitman BR, Waters DD, Théroux P, Hanson JS. S-T segment elevation and coronary spasm in response to exercise. Am J Cardiol 1981;47:1350-8.CrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2018

Authors and Affiliations

  • Ayman A. Farag
    • 1
  • Shane Prejean
    • 1
  • Ami E. Iskandrian
    • 1
  • Fadi G. Hage
    • 1
    • 2
  1. 1.Division of Cardiovascular Disease, Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Section of CardiologyBirmingham Veterans Affairs Medical CenterBirminghamUSA

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