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    Myoview stress test result question
    alan226 posted:
    I very recently had a nuclear stress test with the following results: The patient exercised for 6m 48s with a max HR of 116. SPECT images reveal a normal left ventricular size. There are diminished counts noted within the inferior wall ? related to artifact. Clinical correlation would be required. There is no reversible defects suggestive of ischemia. Overall ejection fraction is 57% as gated imaging was performed. The MD doing the test did not seem overly concerned and also noted that the low HR was due to beta blockers as well as working out on a regular basis. I am a 50 y/o male with HBP for 20+ years, exercise regularly, runner for 10+ years, religiously take my meds, never smoked. Family history of heart disease (father died at 35 y/o). I have an appointment with a cardiologist in 2 weeks. Anything in the test I should be concerned about?? Any followup tests recommended? Any questions I should be asking of my doctor when I see him in 2 weeks??
    CardiostarUSA1 responded:
    Hi: i "Diminished counts noted within the inferior wall ? related to artifact." Noteworthy, a diminished count or attenuation artifact, is a false image, e.g., due to body habitus/anatomy or dense breast tissue, which can show up as either a reversible (ischemic) or fixed (scar tissue) perfusion defect on nuclear stress test images. i "57%" Normal resting range left ventricular ejection fraction (LVEF) is 50%/55%-75%. Average reported is in the low to mid 60s. Cleveland Clinic b Understanding Your Ejection Fraction Your Total Health [Patient guide> b Ejection fraction i "Also noted that the low HR was due to beta-blockers...." By design, beta-blockers, lowers the heart/pulse rate and blood pressure, and also tends to hold back or blunt the heart's response to vigorous exercise/physical activity. i "MD doing the test did not seem overly concerned" In general, the two main concerns regarding a nuclear stress test involves an actual narrowing or scarring, i.e., the findings of reversible (ischemia) or non-reversible (fixed, permanent, scar tissue) perfusion (blood flow) defects. After stress myocardial perfusion imaging (stress MPI, e.g., gated-SPECT scan with Cardiolite or Myoview), one's cardiologist may take some time to study the results of the scan before discussing the findings. One can typically expect one of the following four results - 1: b No perfusion defect after exercise or at rest The heart muscle and blood flow to the heart muscle appear to be normal. 2: b Perfusion defect after exercise, BUT NOT at rest (reversible defect) There is some degree of blockage in a coronary artery that interferes with the blood flow to the heart muscle. In someone with significant heart disease, when the heart works hard, it does not get the blood supply and oxygen that it needs (a supply and demand mismatch). At rest, however, the blood adequately reaches these areas or regions, e.g., ANTERIOR/ANTERO (front wall), POSTERIOR (back wall), INFERIOR (lower area/lower wall area), APICAL/APEX (bottom tip of the heart) and LATERAL (side wall). The heart muscle has living cells/tissue in these areas. This indicates that clearing the blockage in the affected artery will be of benefit. 3: b Perfusion defect AFTER exercise AND at rest (fixed defect) There is one or more totally blocked coronary arteries and one has had damage done to the heart muscle because of a heart attack. There is an area (or areas) of the heart muscle that has become scar tissue (scarring, scarred) because of the MI. This area would not be able to make functional use of any oxygen even if blood flow to that area of the heart were completely restored. 4: b Combined reversible and fixed defects It is common for individuals with coronary artery disease (CAD) to have different degrees of blockages in different arteries. A heart attack has left a fixed defect in one area of the heart, but there is a reversible defect in another area of the heart due to a less severe blockage. . Most important, communicate/interact well with your doctors. Best of luck down the road of life. Take care, CardioStar☑ WebMD community member (8/99) - - b ☑Be well-informed HeartSite b Isotope/Nuclear Stress Test See: Actual rest/stress nuclear images The physician can separate a normal left ventricle, from..... . i Quote ☞"Be a questioning patient. Talk to your doctor and ask questions. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!" - Charles Inlander, People's Medical Society . b It's your there. :-)
    James_Beckerman_MD responded:
    Why did you have the test? Nothing in the results appears very concerning to me!
    alan226 responded:
    Thank you so much. The only thing I was concerned about was the "There are diminished counts noted within the inferior wall ? related to artifact." with clinical correlation required. Does this mean another test?
    James_Beckerman_MD responded:
    It's very common in nuclear stress tests for there to be the appearance of decreased blood flow to the bottom of the heart, especially if the abnormality is mild and is present in both the pre-stress and post-stress images. If this is the impression of the physician reading the study, then I would rarely recommend follow-up testing.

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