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