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Stress Test Results
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joscors posted:
I recently had been experiencing some shortness of breath and the doctor thought I should have a nuclear stress test. I just got the results
back and they said I have slightly reduced blood flow to the bottom of my heart and he is prescribing a beta blocker but not a follow up test such as a CT scan or angiogram. Does this mean that the reduction in blood flow is so slight that its really nothing to worry about?
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cardiostarusa1 responded:
Hi:

"I recently had been experiencing some shortness of breath"

"I have slightly reduced blood flow to the bottom of my heart"

As reported, the symptoms of artery-narrowing atherosclerosis are highly variable. Those with mild atherosclerosis may present with clinically important symptoms and signs of disease and heart attack, or absolute worst case scenario, sudden cardiac death (SCD) may be the first and only symptom of coronary artery disease (CAD). However, many individuals with anatomically advanced disease may have no symptoms and experience no functional impairment.

"I have slightly reduced blood flow to the bottom of my heart"


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.

After stress myocardial perfusion imaging (stress MPI 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/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.

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.

Most important, communicate/interact well with your doctor(s).

Best of luck down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)



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Be well-informed

HeartSite

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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LEARN ABOUT the Heart


WebMD

The Heart: (Human Anatomy) Pictures, Definition, Location in the Body and Heart Problems

http://www.webmd.com/heart/picture-of-the-heart


How the Heart Pumps


Animated Tutorial

http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/heartpump-tutorial.html


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James Beckerman, MD, FACC responded:
Thanks for posting!

Some research studies have suggested that a "low risk" stress test may be further worked up by either doing an angiogram/CT or by prescribing medication with similar results, suggesting that patients tend to do well regardless of the approach. Obviously this should be very patient-specific and test-specific, so a good idea to flush things out with your doctor further to make sure you both have a good plan going forward. Take care!


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