Evidence of walk-through phenomenon during echocardiographic dipyridamole stress test

This case report deals with induced regional wall motion abnormalities that spontaneously disappeared during an echocardiographic stress test with dipyridamole. A patient underwent this test because of atypical chest discomfort and a positive result of exercise stress test. Transient septal, apical and anterior akinesia were observed after the first dose of dipyridamole, but they were short-lasting and did not return during the continuation of the test. Coronary angiography showed a critical stenosis of the left coronary artery. A mechanism similar to that responsible for the walk-through phenomenon might explain the observed findings. Thus stress echo with dipyridamole needs careful continuous monitoring, because transient wall motion abnormalities can otherwise be missed resulting in a false negative test.