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Mild Reversible Ischemia
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sdkbus1 posted:
After having a nuclear stress test I was diagnosed with mild reversible ischemia. My doctor prescribed 81mg asprin, lipitor, and a PET/CT scan. I'm taking the asprin, not sure I want or need to take the lipitor, and do I really need the PET/CT scan at this time. What are your thoughts? I'm 51 and 195 lbs. I've lost over 10lbs over the last 7/8 months, my BP is 140/80, resting heart rate is 55/60. Total cholestrol is 215. LDL is up, trigylcerids are high, and HDL is low. I have a strong family history of heart disease. I am a very active person. I run 15/20 miles a week, walk briskly on non running days, ride a bike, and workout with weights a couple times a week. What should I be doing to put off any agressive procedures for as long as possible? Thanks
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James_Beckerman_MD responded:
First of all, great job on the weight loss and associated healthy lifestyle choices - that's fantastic. Here's the deal. A mildly reversible defect on a nuclear stress test has a very good prognosis, but it may be suggestive of coronary artery disease. Your doctor is taking a less invasive approach by not recommending an invasive angiogram, and for a mildly reversible abnormality, his/her decision is supported by the research. But, an aggressive preventive approach is appropriate. Aspirin and statins have been shown to reduce the risk of heart attacks in people with coronary artery disease, even if asymptomatic. Statins are amazing medications that provide a lot of benefit even beyond lowering cholesterol - antiinflammatory, antioxidant, the list goes on. I suggest you discuss the rationale behind the PET/CT scan a bit further. These tests certainly have value, but they provide significant radiation and are rather costly. You should just have a clear sense of what your doctor is after - and I would also be interested to know if the test is covered by insurance.
 
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CardiostarUSA1 responded:
Hi: One of two main concerns regarding a nuclear stress test is a reversible perfusion defect, which indicates that an area of the heart muscle (myocardium) did not receive an adequate amount of blood (ischemia) at stress, but did so at rest (reversible ischemia), caused by one or more narrowed or restenotic (renarrowed) coronary arteries or bypass grafts. At rest, the blood adequately reached these areas or regions, e.g., anterior (front wall), posterior (back wall), inferior (lower area/lower wall area), apical/apex (bottom tip of the heart) and lateral (side wall). Normal resting blood pressure (BP) is under 120/80, with 110/70 or 115/75 reported as being optimal/ideal. As reported, health dangers from BP vary among different age groups and depending on whether systolic, diastolic, or both, is elevated. Isolated diastolic hypertension, isolated systolic hypertension and diastolic/systolic hypertension, increases the risk of cardiovascular disease, cerebrovascular disease, renovascular disease. High systolic BP appears as a significant indicator for heart complications, including death, in all ages, but especially in middle-aged and older adults. Additionally, pulse pressure (the difference between systolic and diastolic) is important. Usually, the resting (in sitting position) pulse pressure in healthy individuals is 40 mmHg, give or take a bit. A consistently narrow (say 20-25 or less) or consistently wide (say 60-65 or more) pulse pressure is not good. Most important, communicate/interact well with your doctors. Take care, CardioStar☆ WebMD community member (8/99) - - b ☑Be well-informed b Good to know, for the primary/secondary prevention of heart attack/brain attack Epidemiologic studies have revealed risk factors atherosclerosis, which includes age, gender, genetics, diabetes, smoking (also secondhand), inactivity, obesity, hypertension, diet high in fat, saturated fat and cholesterol, 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). b _ . _ b ♥-Healthy Foods i It's never too late Avoid foods high in saturated fat and cholesterol. Choose skim or low-fat milk, low-fat yogurt and reduced-fat cheeses. Eat more fish and poultry. Limit servings to five to seven ounces a day. Trim visible fat. Limit egg yolks. Substitute two egg whites for one whole egg or use an egg-substitute. Eat more fruits and vegetables, whole grains, breads and cereals. Use less salt and fat. Season with herbs and spices rather than with sauces, gravies and butter. b _ . _ WebMD b Heart Disease TYPES Men/Women i Acquired/Congenital www.webmd.com/heart-disease/heart-disease-men b SYMPTOMS www.webmd.com/heart-disease/guide/heart-disease-symptoms Mayo Clinic b Heart Disease Definition. Symptoms. Causes.... Heart disease is a broad term used to describe a range of diseases that affect your heart, and in some.... www.mayoclinic.com/health/heart-disease/DS01120 b HeartSite Heart info, cardiac tests info, actual diagnostic images. b Isotope Stress Test The physician can separate a normal left ventricle, from ISCHEMIA (live muscle with flow that is compromised only during exercise).... www.heartsite.com/html/isotope_stress.html b Coronary artery anatomy Starting with the LAD, the most critical, next to the ultra-critical left main (LM). www.heartsite.com/html/lad.html . 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


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