[Abnormal myocardial blood flow distribution with a normal coronarogram in angina pectoris and after myocardial infarction].

It is reported on the selective coronary perfusion scintigraphy in 47 patients with angina pectoris and condition after myocardial infarction, which was performed simultaneously with the coronary angiography. For the paper were interesting the cases with normal coronarogram, but pathological perfusion scintigram. 3 of 25 patients with condition of infarction showed coronarographically inconspicuous vessels. In all cases the perfusion scintigram shows disturbances of regional perfusion, which corresponded with the electrocardiographic localisation of the infarction. In 3 of 22 patients with angina pectoris with normal coronarogram in the scintigram regional changes of the terminal vascular system were established. In 2 cases simultaneously a disturbance of rhythm and stimulus conduction was present, which showed a conspicuous correlation to the perfusion lesions in the septum. In the small intramural vessels haemodynamically effective changes take place which are below the coronarogram. Therefore, the only coronarography is not enough to confirm or to refuse a genuine angina pectoris or an infarction. The selecitve coronary perfusion scintigraphy gives the possibility to prove disturbances of the distribution of regional blood supply without a greater additional load of the patient as to coronary angiography. However, it cannot give evidence on the genesis of disturbances in the terminal vascular system in the normal coronarogram