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Opinion sought on Stress Thallium test
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pardiprathi posted:
Patient history:

- Age: 71 years
- Had bypass surgery 13 years ago
- Angioplasty 8 months ago

Complaint:

On walking choking of throat, chest pain, upper back pain

Stress Thallium Test:

Data:

Resting heart rate 56 per minute, Blood Pressure 150/90
Protocol adenosine stress heart rate 68 per minute, Blood pressure 140/80
Stress ECG: No ECG changes

Gated SPECT - Stress: EF 66%, EDV 86 ml, ESV 29 ml, wall motion normal

Conclusion:

Gated SPECT cardiac perfusion scan with adenosine intervention and nitrate enhancement is negative for inducible ischemia or hypernating myocardium.

There is evidence of medium sized fixed perfusion defect of high severity involving the basal and mid cavity inferior and inferoseptal wall.

LV cavity is mildly enlarged.

Prognostically, a favorable study and bears intermediate probability for annual risk for major cardiac events.
Reply
 
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cardiostarusa1 responded:
Hi:

What stands out in the data is -

"There is evidence of medium sized fixed perfusion defect of high severity involving the basal and mid cavity inferior and inferoseptal wall."

The Basics

SEE: **fixed defect

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 -

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.

.

HeartSite

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......

http://www.heartsite.com/html/isotope_stress.html

Take care,

CardioStar*

WebMD member (since 8/99)




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WebMD/WebMD forums DOES NOT provide medical advice, diagnosis or treatment.
 
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pardiprathi replied to cardiostarusa1's response:
Hi,

Thanks a lot for your reply and explanation on the basics.

What would be, in general, cardiac physician's take on the heart condition based on the data provided?
 
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cardiostarusa1 replied to pardiprathi's response:
You're welcome.

Especially with the patient's history of coronary artery disease (CAD) and surgical/interventional cardiac procedures, as the data implied,

......"bears intermediate probability for annual risk for major cardiac events."

Take good care,

CardioStar*




-

-


WebMD/WebMD forums DOES NOT provide medical advice, diagnosis or treatment.
 
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cardiostarusa1 replied to cardiostarusa1's response:
Additionally, regarding the condition of the heart, and with the evidence of a past heart attack and the mildly enlarged left ventricle, at least the stress ejection fraction was in normal range.

Cleveland Clinic

Understanding Your Ejection Fraction

http://my.clevelandclinic.org/heart/disorders/heartfailure/ejectionfraction.aspx

More about Left Ventricular Ejection Fraction (LVEF)

**To get a decent estimate of LVEF, a MUGA scan is reported as being the most accurate of the non-invasive methods.

Pertinent excerpt from an article on About.com by cardiologist Richard N. Fogoros, M.D.

When is the MUGA scan more useful than other heart tests?

The advantages of the MUGA scan over other techniques (such as the echocardiogram) for measuring the LVEF are twofold
. First, the MUGA ejection fraction is highly accurate, probably more accurate than that obtained by any other technique. Second, The MUGA ejection fraction is highly reproducible. That is, if the LVEF measurement is repeated several times, nearly the same answer is always obtained. (With other tests, variations in the measured LVEF are much greater.

CardioStar*



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WebMD/WebMD forums DOES NOT provide medical advice, diagnosis or treatment.
 
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pardiprathi replied to cardiostarusa1's response:
Thanks again for your prompt and informative response.

Would angiography as a follow-up exam make sense in such circumstances?

MUGA is unheard of in this part of world
 
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cardiostarusa1 replied to pardiprathi's response:
You're welcome.

Since X-ray angiography is invasive (carries risks and the possibility of complications, some unforeseen), that would be used only when deemed necessary/appropriate, mainly to determine the location and severity (%) of a blockage, or to check the status/patency of a bypass graft or a site that was treated with angioplasty, with or without a stent.

Other than MUGA, gated-SPECT or echocardiography (cardiac ultrasound) is commonly used to measure/estimate LVEF.

CardioStar*



-

-

WebMD/WebMD forums DOES NOT provide medical advice, diagnosis or treatment.


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