Well tolerated, no symptoms, no ECG changes, BP 130/80 mmHg at rest, 120/75 mmHg during the test.
Teaching points:
Myocardial necrosis with a paradoxical pattern (PP) is observed in a few proportion of patients with myocardial necrosis.
Necrotic areas with PP have preserved myocardial flow, owing to either patency of the culprit artery, or the presence of collateral circulation to this territory when the artery is occluded.
Patients exhibiting a PP on MPS with Tc-99m-labeled tracers have a better prognosis and better LV function than patients with a non-PP pattern in necrotic myocardial regions.
PP can also be observed as an artefact in studies with low-count statistics, or if there is dominant attenuation during the stress portion.
QC data should be always checked before interpreting MPS.
