Phantom Ischemia Mimicking ST Segment Elevation Myocardial Infarction in Fulminant Myocarditis / 이화의대지

A 30-year-old man visited the emergency room for chest pain, dyspnea and fever. Despite increased serum cardiac enzymes, ST segment elevation and inferior wall akinesis in electrocardiography and echocardiography, no atherosclerosis was evident in the coronary angiography. However, radionuclide myocardial perfusion image at day 2 showed a persistent perfusion defect in the left ventricular (LV) inferior wall. At day 3, prominent myocardial edema and severe LV systolic dysfunction developed with signs of heart failure. In this case, fulminant myocarditis seemed to originate from the right coronary artery territory and simulated a ST segment elevation myocardial infarction without coronary artery obstruction. The pathogenesis of the localized perfusion defect was unlcear.

A Modified Protocol for Myocardial Perfusion SPECT Using Natural Plant Extracts for Enbancement of Biliorg Excretion / 대한핵의학회잡지

PURPOSE: For good quality of myocardial perfusion images, an approximately 30 min to 1 hour of waiting time after radiopharmaceutical injection and ingestion of fatty meal are asked of the patients. The aim of this study was to investigate the shortening of waiting time after radiopharmaceutical injection and improvement of image quality using natural plant extracts that promote bile excretion. MATERIALS AND METHODS: Ten volunteers participated in protocol 1 (7 men, 3 women; mean age, 24.1+/-2.4 years) and protocol 2 (8 men, 2 women; mean age, 26.1+/-2.9 years), respectively. For the modified method of both protocols, subjects took natural plant extracts 15 minutes before the first injection of 99mTc MIBI without taking fatty meals. Control (Conventional) methods were performed with intake of a fatty meal 20 to 30 minutes after 99mTc MIBI injection. RESULTS: As the results of protocol 1 and 2, the ratio of myocardial to lung ratio were not different between modified and conventional method. Liver to lung ratio of modified method showed significantly lower value than that of conventional method. In modified method, myocardial to liver ratio was higher persistently. In protocol 2, natural plant extracts took before the first injection of 99mTc MIBI exerted accelerating effect of excretion of bile juice into intestine until the end of examination. CONCLUSION: These results represent that natural plant extracts for facilitation of bile excretion before injection of 99mTc MIBI may provide better quality of myocardial perfusion images without the need for preparations such as ingestion of fatty meal within the 2 hours compared with conventional method.