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Coronary anatomy matters: Dual LAD presenting as atypical ischemia on myocardial perfusion imaging

Raza Abbas Mahdi1, Harpreet Singh1, Janarthanan Ilangovan1

  • 1Department of Nuclear Medicine and Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|April 8, 2025
PubMed

Insights

Myocardial perfusion imaging artifacts can mimic coronary anomalies. Awareness of dual LAD anatomy is crucial for accurate interpretation of perfusion defects, preventing misdiagnosis.

Area of Science:

  • Cardiovascular Imaging
  • Nuclear Cardiology
  • Anatomical Variations

Background:

  • Myocardial perfusion imaging (MPI) is vital for assessing coronary artery disease.
  • Imaging artifacts can complicate the interpretation of MPI results.
  • Differentiating true perfusion defects from artifacts often relies on anatomical correlation.

Observation:

  • A case of dual left anterior descending (LAD) artery is presented.
  • The patient exhibited isolated anteroseptal wall ischemia on MPI.
  • This pattern mimicked artifacts typically seen in left bundle branch block (LBBB).

Findings:

  • Coronary anomalies, such as dual LAD, can lead to atypical MPI findings.
  • Standard artifact-detection methods may fail when anatomical variations are present.
  • The observed ischemia was directly related to the anomalous coronary anatomy.

Implications:

  • Familiarity with coronary anatomical variations is essential for accurate MPI interpretation.
  • Misinterpretation of atypical perfusion defects can lead to incorrect clinical decisions.
  • This case underscores the need for integrated analysis of imaging and anatomical data.

Keywords:
Coronary anomaliesDual LADLBBB perfusion artifactMyocardial perfusion imaging

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