Estimation of coronary arteries and myocardial scintigraphy with 201 TI in patients with complete bundle branch block and anginal discomforts
Intraventricular conduction disturbances and particularly bundle branch block are frequently accompanied by anginal discomforts while the finding of coronary arteriography is within normal limits. It is well known that sudden death occurs in these patients, particularly during exercise.
The study involved 38 patients aged, mean age 54 years, who visited their cardiologist because of anginal pain, particularly during exercises. Coronary arteriography was performed in 24 patients out of 30 ones with severe anginal discomforts. In 12 patients the finding of coronary arteriography was normal and in 8 patients out of these 12 abnormal myocardial scintigraphy (fixation defected 201 TI) was found . LAD changes were detected in 7 patients. Patients with normal finding of coronary arteriography and the fixation defect 201 TI had severe anginal discomforts during exercise. Localization of the defect was septal and antero-septal. Changes were irreversible in 5 patients.
Besides, radionuclide equilibrium ventriculography with phase analysis was also performed. It pointed to asynchrony in hearth contraction which was induced by the delay of the antero-septal part of the hearth in systole in respect to other parts of the hearth.
This finding pointed to the existence of myocardial ishemia during exercise in spite of the fact that the finding of coronary arteriography was normal. What was the reason for this ischemia? It was belived that so-called "functional ischemia" was the sequel of prolonged compression of septal arteries resulting from asynchronous contraction of the septum and consecutive augmentation of blood pressure to the walls in the left ventricular outflow tract.
Institute of Cardiovascular Diseases, Faculty of medicine, University of Novi Sad, Serbia.
Z. Stamenkovic, J. Stamenkovic, N. Draganic
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