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- Received August 11, 2009
- Accepted August 23, 2009
- Published online October 27, 2009.
A 43-year-old man was sent to coronary angiography for suspect angina with a positive electrocardiographic treadmill test. The angiogram was negative for coronary artery disease, and the coronaries were defined as “normal” (A), although mild narrowing of the distal left anterior descending artery (LAD) was quite apparent in systole (A, right side arrow). In the persistence of anginal symptoms, a contrast stress-echocardiogram with myocardial perfusion analysis was performed. This test, conducted with dipyridamole (0.84 mg/kg/6 min), showed an inducible subendocardial perfusion defect in the apex and apical septum, otherwise unremarkable at rest (B, Online Videos 1and 2). Very high blood velocities were measurable in the distal LAD, particularly after dipyridamole (but with near-normal Doppler coronary flow reserve) (C). A 64-row computed tomography scan confirmed the intramyocardial course of the mid-distal LAD (D), which is a more common finding than previously thought, on the basis of coronary angiography studies, depending on the known limitations of “luminology” techniques for depiction of anatomical components outside the vessel lumen.
- Received August 11, 2009.
- Accepted August 23, 2009.
- American College of Cardiology Foundation