Question Title: PERSANTINE THALLIUM STUDY

CURRENTLY MY BLLD PRESSURE IS STABLE AROUND 145/89 MM Hg ;MY MEDICATINS ARE

DILTAZEM 90MG EXTENDED RELEASE TABLET --BID
LASIX 10 MG---BID

A 2 D ECHO DONE RECENTLY SHOWED AN E.F OF 65% AND MILDTO MODERATE
CONCENTRIC L V H[BOTH PARAMETERS UNCHANGED FROM A SIMILAR EXAM DONE 4YRS
AGO]

I HAVE OF LATE NOTICED FLEETING CHEST PAINS[NOT LOCATION SPECIFIC,UNRELATED
TO PHYSICAL ACTIVITY, NOT ASSOCIATED WITH SWEATING,NAUSEA ETC]
MY PHYSICIAN HAS ADVICED ME TO UNDERGO A AN ANGIOGRAPHY WHICH I HAVE
DECLINED.

MY QUESTIONS TO YOU ARE AS FOLLOWS:

#1.IF I UNDERGO A PERSANTINE-THALLIUM STUDY WHAT ARE THE CHANCES THAT MY
ISCHAEMIA IF IT EXISTS WILL BE ACCURATELY PREDICTED?

#2.IF,THERE IS ISCHAEMIA PROVEN ON THE PERSANTINE STUDY AND I REFUSE TO
SUBMIT MYSELF FOR ANGIOPLASTY ETC;WHAT MORE CAN BE DONE FOR ME IN TERMS OF MEDICAL
MANAGEMENT OF THE DISEASE?WOULD THE CARDIOLOGIST ADD NITRATES?

#3.WHAT ARE THE HAZARDS OF UNDERGOING A PERSANTINE-THALLIUM STUDY?

IF THERE IS ANYTHING THAT CAN CLEAR MY CONFUSION -IT IS YOUR ESTEEMED
ADVICE;SO PLEASE AMSWER THE QUESTIONS I HAVE RAISED

THANKS AND REGARDS--KAMLA

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Dear KAMLA,

A persantine-thallium test is a nuclear study designed to detect heart ischemia (lack of blood flow). The thallium is a nuclear tracer that is injected into the blood. The heart takes up the thallium which than gives off very low amounts of radiation that are detected by gamma cameras. If a part of the heart is scar it does not take up the thallium and appears as a "cold" spot on the pictures. After resting images of the heart are obtained the persantine is given as a stressor agent. Persantine is particularly useful in persons who cannot undergo treadmill testing. It acts by causing blood vessels to dilate and creates a "steal" effect from blood vessels that have blockages in them. Thus these areas show up on the pictures as areas of ischemia.

Thallium scanning may have false positives and false negatives. That is, it may say there is ischemia where there is no ischemia or it may miss blockages that are present. Doctors use numbers called sensitivity and specificity to describe a test's accuracy. The sensitivity and specificity for thallium is about 90% and 85%. The risks of thallium testing are very low.

I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.