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Pep Scan
An_253693 posted:
Today I had a pep scan with nuclear dye. The nurse contacted me with the results. She said that there were two areas of concern.
1) Small to moderate blockage on lateral wall and 2) Insero apical small blockage.
I asked her if I needed to see the Dr. now, she said he didn't put ASAP on the report. She made a follow-up apt for Oct 1, 2013.
Can you give me any information about the two areas and possible treatment that I would need ? I would like to have the information before my f/u visit with my Dr.

Thank You
cardiostarusa1 responded:

Pep scan?

SPECT or PET scanners are used for cardiac imaging with a radioisotope/radiotracer (nuclear dye).

"1) Small to moderate blockage on lateral wall"

Lateral = side wall of the heart

2) Insero apical small blockage.

Infero = lower area of the heart apical (or apex) = bottom tip of the heart

As applicable, See **2: below - some degree of blockage

The Basics

The two main concerns regarding a nuclear stress test involves an actual (not a false image or artifact) narrowing or scarring, that is, the findings of reversible (ischemia) or non-reversible (fixed, permanent, scar tissue) perfusion (blood flow) defects. 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 'n demand mismatch).

At rest, however, the blood adequately reaches these areas or regions, e.g., ANTERIOR/ANTERO (front wall), POSTERIOR/POSTERO (back wall), INFERIOR/INFERO (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.


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.


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.



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 the following way......

Take care,


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