Shozo Sueda, MD; Kazuaki Mineoi, MD; Tadashi Kondou, MD; Kazuo Yano, MD; Takaaki Ochi, MD; Naoto Ochi, MD*; Hiroshi Fukuda, MD*; Hitoshi Kukita, MD*; Hiroyuki Kawada, MD**; Shouzou Matsuda, MD**; Tadao Uraoka, MD*

Abstract
A patient with variant angina showed similar findings on both the rest and matched exercise ²⁰¹Thallium (²⁰¹Tl) myocardial perfusion scintigrams. The 65-year old man was admitted to hospital because of rest angina. His electrocardiogram during the attack disclosed ST segment elevation on inferior leads. However, emergency coronary arteriogram showed no fixed stenosis. Intracoronary injection of acetylcholine induced a spasm on the distal right coronary artery, but not in the left coronary artery. In the rest ²⁰¹Tl study, septal perfusion was low on the early image, although partial redistribution of this site was observed on the delayed image without the appearance of chest pain or electrocardiographic ischemic change. Similary, in the ²⁰¹Tl exercise study under-gone 2 weeks later, septal redistribution was diagnosed because the early image had decreased septal perfusion. Both the exercise ¹²³I-metaiodobenzylguanidine study and the rest ¹²³I-betamethyl-p-iodophenyl-pentadecanoic acid study showed inferior abnormalities on the early and delayed images. Although a coronary spasm was not induced in the left anterior descending artery with the acetylcholine test, septal redistribution was observed on the delayed image of both the rest and exercise ²⁰¹Tl studies. The mechanism of the redistribution on the rest ²⁰¹Tl study was unclear.
(Jpn Circ J 1998; 62: 785-787)

Key Words: Exercise; Redistribution; Rest; ²⁰¹Thallium; Variant angina

Mailing address: Shozo Sueda, MD, Mizonobechou Koh 7-12, Matsuyama City, Ehime Prefecture 791-0101, Japan