Combined atrial pacing and thallium-201 scintigraphy were performed in a man with multiple coronary artery lesions unable to perform exercise stress testing. Severe angina and ischemic ST depression in the inferior and anterior ECG leads occurred at a peak double product of 22,400 beats-mm Hg/min; thallium-201 scintigraphy showed reversible perfusion defects of the inferior, posterior, and septal segments. After angiographically successful angioplasty of a 95% right coronary artery lesion, repeat atrial pacing/thallium-201 scintig raphy (peak double product 27,750 beats-mm Hg/min) produced mild angina no ST depression in the inferior leads, and a normal thallium-201 scan. This case illustrates the value of the atrial pacing/thallium-201 stress test for evaluat ing the need for, and results of, coronary angioplasty in patients unable to per form exercise stress testing.
Get full access to this article
View all access options for this article.
References
1.
Gruentzig A. : Transluminal dilatation of coronary-artery stenosis. Lancet1:263, 1978.
2.
Linhart JW: Atrial pacing in coronary artery disease, including preinfarction angina and postoperative studies. Am J Cardiol30:603-6101972.
3.
Piessens J., et al: Diagnostic value of clinical history, exercise testing and atrial pacing in patients with chest pain. Am J Cardiol33:351-356, 1974.
4.
Heller GV, et al: The pacing stress test: A reexamination of the relation between coronary artery disease and pacing-induced electrocardiographic changes. Am J Cardiol54:50-55, 1984.
5.
Weiss AT, et al: Atrial pacing thallium scintigraphy in the evaluation of coronary artery disease. Isr J Med Sci19:495-504, 1983.
6.
Stratmann HG , et al: Assessment of coronary artery disease by atrial pacing and thallium-201 myocardial imaging. (Abstract). Clin Res33:231A, 1985.
7.
Kent KM, et al: Percutaneous transluminal coronary angioplasty: Report from the registry of the National Heart, Lung, and Blood Institute. Am J Cardiol49:2011-2020, 1982.
8.
Ischinger T. , et al: Should coronary arteries with less than 60 % diameter stenosis be treated with angioplasty ? Circ68:148-154, 1983.
9.
Johnstone DE , et al: Comparison of exercise radionuclide angiocardiography and thallium-201 myocardial perfusion imaging in coronary artery disease. Am J Cardiol45:1113-1119, 1980.
10.
Hirzel HO, et al: Thallium-201 exercise scintigraphy after percutaneous transluminal angioplasty of coronary artery stenosis. Med Clin North Am64:163-176, 1980.
11.
Gotsman MS, et al: Atrial pacing in the diagnosis of ischemic heart disease. Heart Lung12:372-382, 1983.
12.
Tzivoni D., et al: Early right atrial pacing after myocardial infarction. I. Comparison with early treadmill testing. Am J Cardiol53:414-417, 1984.
13.
Tzivoni D., et al: Early right atrial pacing after myocardial infarction. II. Results in 77 patients with predischarge angina pectoris, congestive heart failure, or age older than 70 years. Am J Cardiol53:418-420, 1984.
