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Nuclear Cardiology

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Cardiovascular Medicine

Abstract

Briefly, the underlying physiological principles of stress-rest perfusion imaging are as follows: at rest, coronary flow is normal even in the presence of a narrowing of up to 85% diameter stenosis (Fig. 6.1).1 Stress, usually in the form of dynamic exercise or vasodilatation, results in an increase in coronary flow. In a normal coronary artery, flow increases 2- to 2.5-fold with dynamic exercise or by three- to fourfold with maximal coronary vasodilation.2–6 However, the increase in flow in a stenosed coronary is attenuated. Despite an increase in flow proximally, there is an increase in the pressure gradient across the stenosis, resulting in a drop in pressure and flow distal to the stenosis. This causes a heterogeneous distribution of blood flow during stress, with a greater increase in myocardial perfusion in the area subtended by the normal coronary artery relative to the myocardium supplied by the stenotic artery. In certain circumstances, coronary flow may actually decrease distal to the stenosis, resulting in subendocardial ischemia. This phenomenon of myocardial steal may occur in two circumstances. In the presence of a severe coronary stenosis, the coronary pressure distal to the stenosis may decrease enough during stress that it is insufficient to perfuse the endocardium, resulting in subendocardial ischemia despite an increase in total flow in the proximal epicardial artery.

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Authors and Affiliations

  1. Department of Internal Medicine Division of Cardiology, University of Missouri—Kansas City/Mid America Heart Institute, Kansas City, MO, USA

    Arthur Iain McGhie MD

  2. Department of Medicine, The University of Texas Medical School, Houston, TX, USA

    K. Lance Gould MD

  3. Texas Heart Institute, The University of Texas Health Science Center at Houston, Houston, TX, USA

    James T. Willerson MD

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Editors and Affiliations

  1. The University of Texas Health Science Center in Houston, Houston

    James T. Willerson MD (President, President-Elect and Medical Director) (President, President-Elect and Medical Director)

  2. Texas Heart Institute, Houston, TX, USA

    James T. Willerson MD (President, President-Elect and Medical Director) (President, President-Elect and Medical Director)

  3. Department of Cardiology, University of Maastricht, Masstricht, The Netherlands

    Hein J. J. Wellens MD (Emeritus Professor) (Emeritus Professor)

  4. Rasmussen Center for Cardiovascular Disease Prevention Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA

    Jay N. Cohn MD (Professor of Medicine and Director) (Professor of Medicine and Director)

  5. Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

    David R. Holmes Jr. MD (Consultant, Professor of Medicine and Scripps Professor) (Consultant, Professor of Medicine and Scripps Professor)

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McGhie, A.I., Gould, K.L., Willerson, J.T. (2007). Nuclear Cardiology. In: Willerson, J.T., Wellens, H.J.J., Cohn, J.N., Holmes, D.R. (eds) Cardiovascular Medicine. Springer, London. https://doi.org/10.1007/978-1-84628-715-2_6

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