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Lexiscan Sestamibi Scan Results
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shortwind posted:
I am an adult-onset asthmatic with a history of multiple exacerbations, many including bacterial asthmatic bronchitis. I have persistent dsynea with walking faster than a strolling pace, which worsens during a flare-up. My pulmonologist wanted to rule out heart issues, so he had me take the Lexiscan stress test (I get too short of breath too fast to successfully complete a treadmill test). I had the test on 10/14/10 and 10/18/10. Last week, my pulmo's office called me and told me they had set up an appointment with a cardiologist for Nov. 15, saying something about "abnormality". Yesterday (Nov. 5) I managed to obtain a copy of the report from my primary care doctor. The results suggest myocardial scarring. The Summed Stress Score is 10 and Summed Resting Score is 6. Now there may be some artifact, as well. Meanwhile, I have very good cholesterol readings, I am NOT diabetic, I have NEVER smoked, I am a 58 year old female, maybe 10-20 pounds overweight, but NOT obese. For many years I did daily brisk walks, though since my lungs worsened with a severe bronchitis in 03, I do daily strolls instead, unless I am in a flare-up. I have no knowledge of ever having a heart attack. No unusual childhood infections, either...though had tonsils out at age 6. So, assuming there is some scarring, what could have caused it? And could it be a contributor to my shortness of breath with exertion? Oh, my ejection fraction is 72 percent, which I understand is good.
Thanks!
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CardiostarUSA1 responded:
Hi:

"I have no knowledge of ever having a heart attack."

As applicable, a "silent MI" may/can occur.

CNN Health

Silent' heart attacks more common than thought, study says - April 21, 2009

Silent heart attacks affect nearly 200,000 people in the United States annually

Although many people think of a heart attack as a painful, sometimes fatal event, there are some heart attacks that go entirely unnoticed......

http://www.cnn.com/2009/HEALTH/04/21/silent.heart.attacks/index.html

"My ejection fraction is 72 percent"

Normal resting range LVEF is 50%/55%-70%/75%.

Understanding Your Ejection Fraction

http://my.clevelandclinic.org/heart/disorders/heartfailure/ejectionfraction.aspx

"Results suggest myocardial scarring."

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 -

1:

No perfusion defect after exercise or at rest

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

2:

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 'n 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), Septal/Septum (dividing wall) 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:

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/areas of the heart muscle that has become scar tissue (scarring, scarred) because of the heart attack.

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:

Combined reversible and fixed defects

It is common for individuals with coronary artery disease 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.

"There may be some artifact"

An 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.

Take care,

CardioStar*

WebMD member (since 8/99)



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Be well-informed

HeartSite

Isotope/Nuclear Stress Test

SEE: Actual rest/stress images

http://www.heartsite.com/html/isotope_stress.html

Coronary artery anatomy

http://www.heartsite.com/html/lad.html

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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
 
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shortwind replied to CardiostarUSA1's response:
Hi CardiostarUSA1:

Thanks for taking the time to provide your detailed reply. Lots of food for thought. As I noted, I will be seeing the cardiologist Nov. 15. Hopefully, I will have more clarity after that visit. Nevertheless, I sure don't fit the typical "heart attack" profile.
Shortwind


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