{"id":22612,"date":"2017-11-20T22:39:31","date_gmt":"2017-11-20T17:09:31","guid":{"rendered":"https:\/\/cardiophile.org\/?p=22612"},"modified":"2017-11-20T22:39:31","modified_gmt":"2017-11-20T17:09:31","slug":"balanced-myocardial-ischaemia","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/balanced-myocardial-ischaemia\/","title":{"rendered":"Balanced myocardial ischaemia"},"content":{"rendered":"<h2><span style=\"color: #008000;\">Balanced myocardial ischaemia<\/span><\/h2>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/-p54cWGIjKg\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #0000ff;\">If all three major coronary branches have similar degree of stenosis, the radionuclide used for perfusion study will have equal uptake in all regions of the myocardium.<\/span> Thus a balanced three vessel coronary artery disease can produce a <span style=\"color: #0000ff;\">false negative myocardial perfusion scan<\/span>. This situation is called\u00a0<span style=\"color: #ff00ff;\"><em>balanced myocardial ischemia<\/em><\/span>. In most cases this is picked up by the treadmill ECG usually done along with stress myocardial perfusion imaging. Since the ECG findings of myocardial ischemia does not depend on the relative perfusion in the coronary tree, ischemic changes will be noted in treadmill ECG even when nuclear perfusion study shows false negative due to balanced myocardial ischemia.<\/p>\n<p>In a case reported in\u00a0<em>Heart\u00a0<\/em>[1], adenosine technetium (Tc99) sestamibi scan showed no resting or stress induced perfusion defects in an elderly person with stable exertional chest pain. But ST segment depression was noted on the ECG. Coronary computed tomography (CT) angiogram showed severe calcified ostial left main lesion, which was further confirmed by invasive coronary angiography. The patient underwent successful coronary artery bypass surgery.<\/p>\n<p>In another case report published in\u00a0<em>Heart International<\/em>, there was triple vessel coronary artery disease including 95% distal left main stenosis, with markedly positive stress ECG and a negative SPECT 99m-sestamibi scintigraphy [2]. This patient also underwent successful coronary artery bypass surgery.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Other potential causes of false negative nuclear perfusion studies<\/span><\/strong><\/p>\n<p>Other potential causes of false negative nuclear perfusion studies are lesions in the left circumflex coronary artery, use of antianginal agents prior to the test and low levels of exercise leading to low myocardial oxygen demand. Caffeine use can interfere with dipyridamole stress nuclear perfusion imaging due to drug interaction.<\/p>\n<p>As a corollary, balancing of electrical vectors in opposite directions have been invoked to explain false negative exercise treadmill ECGs in patients with multivessel coronary artery disease [3].<\/p>\n<p><span style=\"color: #0000ff;\"><strong>References<\/strong><\/span><\/p>\n<ol>\n<li>Lesser JR, Bae R, Flygenring B, Sharkey SS, Lindberg J, Schwartz RS.\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1768995\/\">Balanced myocardial ischaemia: a case of \u201cnormal\u201d stress Tc99 sestamibi scan and diagnosis<\/a>.\u00a0Heart. 2005 Jul; 91(7): e53. (Free full text).<\/li>\n<li>Aziz EF, Javed F, Alviar CL, Herzog E.\u00a0Triple vessel coronary artery disease presenting as a markedly positive stress electrocardiographic test and a negative SPECT-TL scintigram: a case of balanced ischemia.\u00a0Heart Int. 2011 Sep 29; 6(2): e22.<\/li>\n<li>Madias JE, Mahjoub M, Valance J.\u00a0The paradox of negative exercise stress ECG\/positive thallium scintigram. Ischemic ST-segment counterpoise as the underlying mechanism.\u00a0J Electrocardiol. 1996 Jul;29(3):243-8.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Balanced myocardial ischaemia If all three major coronary branches have similar degree of stenosis, the radionuclide used for perfusion study will have equal uptake in all regions of the myocardium. Thus a balanced three vessel coronary artery disease can produce a false negative myocardial perfusion scan. This situation is called\u00a0balanced myocardial ischemia. In most cases [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":31496,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[14],"tags":[],"class_list":["post-22612","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nuclear-cardiology"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Balanced myocardial ischaemia - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"description\" content=\"Balanced myocardial ischaemia is seen if all three major coronary branches have similar degree of stenosis, causing false negative myocardial perfusion scan\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/balanced-myocardial-ischaemia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Balanced myocardial ischaemia - 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