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Transient Mitral Regurgitation: An Adjunctive Sign of Myocardial Ischemia During Dipyridamole-Thallium Imaging

Departments of Cardiology and Nuclear Medicine, Maisonneuve-Rosemont Hospital Center, Montreal, Canada

Correspondence: For reprints contact: Jean Lette, MD, Maisonneuve-Rosemont Hospital, 5415 Assomption Blvd., Montreal, Canada H1T-2M4.

ABSTRACT

A patient developed transient exacerbation of a mitral insufficiency murmur and a reversible posterior wall perfusion defect during dipyridamole-thallium imaging. Coronary angiography showed significant stenoses of both the right and the circumflex coronary arteries that supply the posterior papillary muscle. Cardiac auscultation for transient mitral incompetence, a sign of reversible papillary muscle dysfunction, is a simple and practical adjunctive test for myocardial ischemia during dipyridamole-thallium imaging. It may confirm that an isolated reversible posterior wall myocardial perfusion defect is truly ischemic in nature as opposed to an artifact resulting from attenuation by the diaphragm.