SEVERE TRANSMURAL MYOCARDIAL-ISCHEMIA AFTER DIPYRIDAMOLE ADMINISTRATION IMPLICATING CORONARY STEAL

Myocardial perfusion imaging with coronary vasodilators is routinely u sed for patients with suspected coronary disease who are unable to exe rcise. Since these agents work by increasing blood flow without signif icantly changing myocardial oxygen demand, they generally do not produ ce ischemia. A minority of patients show evidence of ischemia which so me investigators suggest is due to a coronary steal phenomenon, but th is has been challenged by several investigators. We present the case o f a patient who developed severe transmural myocardial ischemia manife sted by ST-segment elevation and severe perfusion defects which occurr ed after dipyridamole administration and which were reversed with amin ophylline and nitroglycerin. This case supports the notion that corona ry vasodilation with dipyridamole can induce a coronary steal.