Atypical sympotons (right are discomfort st stress).
Echocardiography revealed LVH.
Submitted for stress myocardial perfusion study (MPS).
Teaching points:
Although TID is usually higher in patients with LAD ischemia or multivessel disease (MVD), it can also be found in patients with LVH or diabetes (like in this case).
However, TID in the absence of evident perfusion abnormalities should always raise the question of balanced myocardial ischemia in the first place, which is more common in MVD.
Exercise/rest MPS was performed with 99m-Tc-sestamibi.
