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(Circulation. 1999;99:1644-1645.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Right Ventricular Ischemia by Exercise-Induced Coronary Spasm of the Right Ventricular Branch

Hiroki Sugihara, MD; Noriyuki Kinoshita, MD; Akihiro Azuma, MD; Masao Nakagawa, MD

From the Department of Radiology (H.S.), and the Second Department of Medicine (N.K., A.A., M.N.), Kyoto Prefectural University of Medicine, Japan.

Correspondence to Hiroki Sugihara, MD, Department of Radiology, Kyoto Prefectural University of Medicine, Kajii-cyo, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-0841, Japan.

	Introduction

 
Multiple-gated radionuclide ventriculography (RNV) with ^99mTc-labeled human serum albumin was performed on a 63-year-old man suspected of having angina pectoris. RNV was obtained in the left anterior oblique position at rest and during exercise. During mild exercise, the patient had chest pain, and an ECG showed ST-segment elevation in leads II, III, aVF, and V₁ through V₅. After we acquired exercise data, 0.3 mg of nitroglycerin was administered sublingually, and then RNV was obtained again. Al-though RNV at rest showed only mild hypokinesis of the septal wall, that during exercise (EX) showed akinesis of the right ventricular free wall. This abnormal wall motion in the right ventricle improved after administration of nitroglycerin (NTG) (Figure 1). A coronary arteriogram revealed spasm of the right ventricular branch of the right coronary artery provoked by administration of intracoronary ergonovine (Erg.) maleate (Figure 2). The ECG showed ST-segment elevation similar to that during exercise (Figure 3).

View larger version (73K): [in this window] [in a new window]   Figure 1. Top, Left ventricular perimeter at end-diastole (yellow) and at end-systole (red) in left anterior oblique projection at rest (left), during exercise (middle), and after nitroglycerin administration (right) showed akinesis of the right ventricular free wall induced by exercise. Bottom, Functional images obtained by phase analysis showed marked contraction delay of the right ventricular free wall during exercise.

View larger version (88K): [in this window] [in a new window]   Figure 2. Right coronary arteriogram revealed spasm of the right ventricular branch provoked by ergonovine maleate (Erg.). ISDN indicates isosorbide dinitrate.

View larger version (33K): [in this window] [in a new window]   Figure 3. Electrocardiogram during spasm showed ST-elevation in II, III, aVF, and V1 through . . . [Full Text of this Article]

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