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possible heart blockage
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An_247137 posted:
My husband just got his stress test with nuclear dye results today and it stated he had a lateral reversible defect. What is this? Does this 100 percent prove that there is a blockage for sure. The insurance would not pay for the slice scan of the heart but will pay for the catherization. Is this standard procedure? Isn't the scan more effective without having an invasive procedure like catheterization? The doctor also stated that the diaphram could be pressing against the heart and maybe this could have affected the results. He is going to the hospital this Friday. What do you think?
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cardiostarusa1 responded:
Hi:

"The insurance would not pay for the slice scan of the heart but will pay for the catheterization. Is this standard procedure? Isn't the scan more effective without having an invasive procedure like catheterization?"

Dr. Beckerman can provide insight on that specifically.

In the meantime -

......"it stated he had a lateral reversible defect"

"What is this?"

Lateral = side wall

Reversiblle defect = myocardial ischemia (**see detailed info below)

"The doctor also stated that the diaphram could be pressing against the heart and maybe this could have affected the results."

It's a possibility, and thus would cause, what is referred to as an artifact, which is a false image (as reported from breast attenuation, diaphragmatic attenuation, and other sources of artifacts). An artifact causes a false-positive (F-P) result'finding, indicating a problem when there actually isn't one.

Gated-SPECT (synced to an electrocardiogram/ECG), with technetium-based radioisotopes Cardiolite or Myoview, improves the diagnostic accuracy by aiding in differentiating attenuation artifacts.

The Basics

The two main concerns regarding a nuclear stress test involves an actual narrowing or scarring, that is, the findings of reversible (ischemia) or non-reversible (fixed, permanent, scar tissue) perfusion (blood flow) defects.

After stress myocardial perfusion imaging (stress MPI), 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.

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Best of luck to your husband and you down the road of life.

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

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

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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