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What does "small distal anterior defect present" mean on a nuclear stress test?
T4MEE posted:
this is on the imaging findings on my stress test, but i don't know what it means. does anyone know what it means? thanks
CardiostarUSA1 responded:

The question is, is it a reversible or a fixed defect?

Distal = furthest from the point of origin.

Anterior = front (front wall of the heart)

Small refers to the the size of the defect.

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), the patient'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 -


No perfusion defect after exercise or at rest

The heart muscle and blood flow to the heart muscle appear to be normal.


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.


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.


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.

Take extra-good care,




Be well-informed


Isotope/Nuclear Stress Test

SEE: Actual rest/stress nuclear images

The physician can separate a normal left ventricle, from ischemia (live muscle with flow that is compromised only during exercise) and the scar tissue of a heart attack. The distinction is made in....

Coronary artery anatomy

Starting with the left anterior descending (LAD), the most critical, next to the ultra-critical left main (LM)

_ . _

Identified risk factors for atherosclerosis includes age, gender, genetics, diabetes, smoking, inactivity, obesity, hypertension, high LDL, high Lp(a), high ApoB, high Lp-PLA2, high triglycerides, LOW HDL (less than 40 mg/dL, an HDL level of 60/65 mg/dL or more is considered protective against coronary artery disease), high homocysteine, and high C-reactive protein (CRP/hs-CRP).

._ . _

It's your there. :-)
T4MEE replied to CardiostarUSA1's response:
Hey Cardio Star...thanks for the info. i am still a little confused on this though so here are my exact findings: On cine loop there is breast attenuation artifact noted. The perfusion images demonstrated a homogeneous distribution of the tracer in the resting and stress images. There was a small distal anterior defect present in the resting and stress images, probably related to the breast attenuation artifact. The computer generated ejection fraction is 68%. End diastolic volume is 85 mL. Normal motion and thickening of all left ventricular walls.....That is exactly what it said, but no one explained it to me. I changed cardiologists and he said he would do a heart cath even though he doesn't think I need one. I am not overly anxious to do it either, however if this seems like a blocked artery I will probably have it done. My main problem is PSVT's and palpitations and chest pain that when I go to the ER they say is not heart related. I did have low voltage qsr on my ekg, and normal sinus rhythm with sinus arrhythmia. This whole mess is ruining my life. I am a worrier and I am consumed with finding out what this all means, but when I ask the doctor, he says everything is fine. Well it isn't fine. I actually feel like I have a virus that is attacking my whole system--every night when I lay down, I feel my heart pounding in the mattress. I take xanax at night just so I can get some sleep. I am not big on drugs, and right now I am only taking 20 mg of propranalol a day to help control the psvt's...the doctor keeps saying that amount won't help, but it has helped, plus my blood pressure is low normally and i couldn't function on much more. Anyway, I was not sure about the "profusion" part of the dx. Thanks for your help...Send me a bill---you are much more informative and caring than any of my doctors. God bless.
CardiostarUSA1 replied to T4MEE's response:
You're welcome, and thanks for providing additional results from the nuke test.

"......probably related to the breast attenuation artifact."

A false-positive finding?

Noteworthy, an 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.

"The computer generated ejection fraction is 68%".


Left ventricular ejection fraction (LVEF) is the single-most important clinical indicator of how well the heart is pumping out blood from the left ventricle (LV) to the body (except the lungs, which is handled by the right ventricle) with each beat. Average reported resting LVEF is in the low to mid 60s.

Cleveland Clinic

Understanding Your Ejection Fraction

"I changed cardiologists and he said he would do a heart cath even though he doesn't think I need one."

Presently, it doesn't look like you need that.

While invasive heart catheterization carries risks and the possibility of complications (some unforeseen), as applicable, there is non-invasive 64-slice Cardiac CT, which allows doctors to view/examine the heart and the coronary arteries in never-before-seen detail.

Far better yet, as reported, and if available in your area, the new blazingly fast (benefit of less radiation exposure to the patient, and less contrast media) 320-slice Cardiac CT scanners can measure subtle changes in blood flow, or minute blockages forming in blood vessels, no bigger than the average width of a toothpick (1.5 mm) in the heart, and the brain.

"But when I ask the doctor, he says everything is fine. Well it isn't fine."

You know your body best.

Take extra-extra good care,



It's your there. :-) :cool:
T4MEE replied to CardiostarUSA1's response:
Dear Cardio Star

Again, many thanks for your answers. I have looked into the 64 slice ct scan but haven't found any place near me that does them--but i will continue to look for one as I'm sure more radiology places will be getting them soon. Take care and thanks so much. God bless.


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