Case presentation:

• Male.
• 50 y.o.
• Dyslipidemia.
• Abnormal rest ECG (repolarization changes).
• Asymptomatic.
• MPS performed because of atypical angina.
• Exercise/rest, 2-day protocol, 99mTc-MIBI.

Teaching points:

• TID is usually found in patients with LAD ischemia or multivessel disease (MVD).
• TID – even in the absence of evident perfusion abnormalities – should raise the question of balanced myocardial ischemia, which is common in MVD.
• A drop in post-stress EF is another marker of severe CAD.
• After a succesful revascularization procedure, most transient MPS abnormalities can resolve.