Iqbal S Khan, Salim M, Sania Nishtar, Naseer Ahmed, Afzal Mattu.
Rest MIBI scanning: role in primary angina.
J Pak Inst Med Sci Jan ;14(2):808-9.

A 55-year-old lady presented to our hospital with ischaemic type chest pain progressing from angina class 1 to 3 over 15 days. Ten days prior to presentation a sudden increase in the chest discomfort was experienced and she became unable to carry out her routine chores. She had no risk factors for coronary artery disease and her past medical history was unremarkable. At the time of presentation to the hospital she appeared to be a distressed middle age lady with a regular pulse of 80/minute and BP of 130/80 mm Hg. Cardiovascular examination revealed normally audible first and second heart sounds and a soft fourth heart sound. Examination other than that was unremarkable. Her laboratory parameters were normal. Twelve lead ECG showed 1-mm horizontal ST segment depression in the infro-lateral leads. She was labelled as a case of unstable angina and was treated with oral aspirin, intravenous nitrates, intravenous heparin and oral diltiazem. Her pain was relieved with in four hours of admission. The following morning Resting Technitium labeled MIBI scan showed severe hypoperfusion of the anterior wall, apex and septum. These findings on the rest Tc-MIBI scan were in contrast to the ECG findings which suggested narrowing of the right coronary or the dominant Circumflex coronary artery. We proceeded with a diagnostic coronary angiogram, which revealed an isolated tight stenosis of the proximal left anterior descending artery with no evidence of disease in other areas. The patient was successfully stented a month down the line with subsequent follow-ups being unremarkable. Stress Thallium assessment 4 months after the procedure shows a normally perfused myocardium. The patient is on regular follow up and enjoys a good quality of life.

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