An uncommon case of subendocardial infarction studied by technetium-99m stannous pyrophosphate myocardial scintigraphy

The patient was a 61-year-old female. Her occupation was an office clerk. The chief complaint was anterior chest pain. She was diagnosed subendocardial infarction by her clinical symptoms and electrocardiograms. Peak CPK was in the low level. But sup(99m)Tc-PYP scintigraphy was performed about 30 hours after her admission and showed abnormal dense accumulation in the anterior wall of the left ventricle. On sup(99m)Tc-PYP scintigraphy, subendocardial infarctions have been reported to show lower accumulation than transmural ones in many cases. But in this case coronary arteriography showed almost normal pattern and peak CPK was low in spite of abnormal accumulation on sup(99m)Tc-PYP scintigrams. This was considered to be a very rare case. The deeper understanding of peripheral ischemic changes is essential for explaining this state. (author)