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Stress Test Results
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keithj72 posted:
I had a Nuclear, Thallium Stress Test performed yesterday. I am 40 years old 5'6 124lbs. and I have a history of and MI in 1998 and Angioplasty with stent placement at the time of the MI in 1998. Stent is placed in the "Widow Maker" Artery as my doctor calls it. My Cardiologist called with my results shortly after the Stress Test and told me that I have REVERSE ISCHEMIA. First of all what is this? He explained quickly that my heart isn't getting enough blood flow. I am on Atenolol 50mg once daily and he has now increased this to 100mg in the morning and then another 25mg in the evening. Is this increase in medication going to fix the problem? Or will I eventually have to have another Heart Catherization? It didn't seem to be that serious of a problem, Atleast that's the feeling I got from the quick phone call from my doctor? Should I be worried?
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James Beckerman, MD, FACC responded:
Reversible ischemia suggests that a portion of your heart is receiving less blood flow during stress than at rest. It can suggest a blockage in one (or more) of your coronary arteries. I don't know if your doctor will recommend another angiogram - it may depend on what types of symptoms you may have.
 
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keithj72 replied to James Beckerman, MD, FACC's response:
The symptoms I am having on and off are: Burning in my chest and tightness in my chest only when I do strenuous activity or walk up and down the 12 steps to my basement. I do not exercise regularly but am going to start a program in the Spring. I should also note that at the time I had my heart attack back in 98 my symptoms were burning in the chest as well as the other usual heart attack signs. I explained all of this to my doctor. I also had an Echocardiogram the same day as my stress test. I am a new patient to this cardiologist as my previous cardiologist moved out of state! He was the Chief Cardiologist at UPMC Presbyterian Hospital In Pittsburgh, PA. Dr. Barry London. He was my doctor from 1998 until Nov. 2012. I am thinking about going back to the UPMC Presby Group of physicians for a second opinion as they know my cardiac history very well! My current physician said nothing about a follow-up appointment or anything else for that matter, Just to increase the Atenolol to 100mg in the A.M. and another 25mg in the P.M. This news scares me a bit and I feel like it was just brushed off as nothing very serious and it is very serious to me since I have an extensive heart history. Should I ask for another test such as the angiogram or do you think a second opinion would be best? If I have another blockage wouldn't it be best to have another heart cath and possibly another stent placed? Or is this the common practice to use medication to fix this type of problem? Thank You very much Dr. Beckerman for your reply/s! I see by your very Impressive Credentials that you are perfectly qualified for this kind of medical issue!
 
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billh99 replied to keithj72's response:
As a patient let me give my thoughts.

Personally I would expect/demand a followup visit and have a number of questions.

Now every is not as detailed as I am, but I like to research and understand as much as I can. Before the followup I would get a copy of the reports of the test and learn what I can about the results so I have specific questions.

You have symptoms. I would ask what treatment plan is and what that is expected to accomplish. And how long before a followup to see how it is working.

A second opinion certainly would not hurt. Specially if they had done a Thallium Stress Test in the past so that they have something to compare to the new test.

(And if not done already, make sure the new doctor has full copy of the past records).
 
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cardiostarusa1 responded:
Hi:

"My Cardiologist called with my results shortly after the Stress Test and told me that I have REVERSE ISCHEMIA. First of all what is this?"

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.

"Is this increase in medication going to fix the problem?"

Fix, no.

"Should I be worried?"

Yes, of course.

Most important, coronary stents (bare-metal or drug-eluting) are only a Band-aid or spot treatment, as it doesn't address the disease process and what drives the progression.

Coronary artery disease (CAD) is a lifelong unpredictable (can exhibit periods of stabilization, acceleration, and even some regression) condition, requiring a continuum of care, as well as good doctor-patient/patient-doctor communication and understanding at ALL times.

Best of luck down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)

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Living with Coronary artery disease (CAD)

CAD is a chronic disease with no cure. When you have CAD, it is important to take care of your...

This is especially true if you have had an interventional procedure or surgery to improve blood flow to the heart../It is up to you to take steps...

Recognize the symptoms....

Reduce your risk factors....

Take your medications...

See your doctor for regular check-ups...

http://www.webmd.com/heart-disease/guide/living-with-heart-disease

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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!"

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