A Case of Isolated Septal Myocardial Infarction: Myocardial Perfusion-Metabolism Mismatch as a Tool for Diagnosis

Figures

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  Figure 1. Serial electrocardiograms for a 46-year-old male. (a) On admission, ST-segment elevation in leads V1 to V2, and negative T waves in I, aVL, and V2 to V5 were seen. (b) These findings were still present the next day, (c) but improved five days after admission, and (d) almost disappeared one month later. Note: lack of septal q waves in V5 and V6 during the clinical course.

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  Figure 2. Coronary angiography and intravascular ultrasound imaging. (a) We observed no significant stenosis in the main artery, but flow delay in the second septal branch of the left anterior descending (LAD) was present (red arrow). (b) Intravascular ultrasound images revealed a mild to moderate amount of plaque burden in the proximal portion of the septal branch, in the absence of atherosclerotic changes in the left ascending coronary artery (asterisk), whereas (c) no atherosclerosis was observed in the mid- to distal portions of the septal branch. (d) Following the procedure, angiography revealed improved flow in the septal branch with no flow delay. (e) Follow-up angiography performed six months later, demonstrated good blood flow in the septal branch.

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  Figure 3. Resting nuclear imaging. (a) Thallium-201 bulls-eye map showed no perfusion defect five minutes after injection, (b) but mildly reduced tracer uptake or reverse redistribution in the ventricular septum three hours later (red arrow). (c) Mildly reduced I-123-beta-methyl-p-iodophenyl-pentadecanoic (BMIPP) uptake on the initial bulls-eye map (red arrow) with (d) high washout on the delayed image.