PMC5314671_01
(a) Baseline electrocardiogram before adenosine infusion showing normal sinus rhythm with heart rate of 78/min. (b) Electrocardiogram at the end of 2nd min of adenosine infusion showing heart rate of 98/min and wide QRS interval of 200 ms. (c) Electrocardiogram reverts to normal at 2:50 min of the recovery phase with heart rate of 90/min
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F1
Her baseline HR and BP was 75/min and 130/70 mmHg respectively, and baseline ECG was normal [Figure 1a]. She developed LBBB with a QRS width of 200 ms at the end of 2nd min of adenosine infusion at the HR of 93/min [Figure 1b]. 7 mCi of technetium-99m (Tc-99m) tetrofosmin was injected intravenously at a 3rd min of infusion and adenosine infusion was continued for 3 min after radiotracer injection. Patient's ECG reverted back to normal at 2:50 min into recovery phase when the HR was 90/min [Figure 1c].
Stress and rest images reveal a nonreversible perfusion defect of mild severity in the apical anteroseptum
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PMC5314671_01_WJNM-16-78-g002.jpg
F2
Considering adenosine-induced LBBB, the findings of the stress-MPI were interpreted as likely due to LBBB-induced artefact [Figure 2].