Pllease help with Stress test results and prognosis

[LeLe1962]

Could you please help me understand my stress test results.  I am scheduled for a cath on September 9th and am very nervous.  Can this be fixed and what is the prognosis?  Am I in any danger of having a heart attack before I can get the cath??  My doctors seem to think its not an emergency.  I was in the hospital for 2 days last week with chest pain.  

Stress Test Results
Exercised for 6 minutes and 30 seconds of a Bruce Protocol.  Heart rate increased to 151 which was 86% of her perdicted maximal heart rate.  Blood pressure was 124/92 at baseline
1.  Adequate exercise with heart rate of 151 which is normal for her age and condition.
2.  Exercise treadmill test is equivocal for ischemia at 86% of her predicted maximal heart rate.
3.  Normal hemodynamic response to exercise.
4.  Stress test is positive for chest discomfort of uncertain etiology.
5.  Please correlate with stress myocardial perfusion scan.

The patient was injected  with 3.3 mCi of Thallium Chloride and resting images were obtained.  Subsequently, the patient exercised on the Bruce protocol for 6 minutes and 30 seconds.  At peak exercise the patient waws injected with 29 mCI of Technetium Sestamibi and stress images were obtained.  Subsequently, tomographic inaging with gated acquisition was obtained.

Findings.:  Anteroapical wall - There is a small sized areal of mild intensity defect which was partially reversible.  Lateral wall - normal.  Septal wall - normal.  Inferior wall- normal.  Gated Spect imaging showed normal left ventricular size with an ejection fraction of 70 %.
1.   Abnormal myocardial perfusion study with a partially reversible defect in the anteroapical segment.
2.  Normal LV size with an ejection fraction of 70 %.
What does this mean?  Do I have a blockage?  Does this warrant a heart cath?  I'm still having chest pains and discomfort.  Not sure where these pains are coming from.  Please help.

Thank you!   What is my prognosis with this???

[Lee Kirksey, MD]

Hello
I posted a response to you promptly yesterday however it was not posted.

It appears that your atypical chest discomfort prompted this test. I would be interested in your age, family history, medical history of diabetes, hypertension, cholesterol panel, smoker? weight.

Your stress test was suspicious for the development of chest discomfort as well as an abnormal appearing segment at the apex of your heart. the stress test looks for areas of reversible low blood flow that can potentially be corrected with meds or an intervention. It would be unclear which is more appropriate until your findings are revealed. The good thing is that your heart function is normal and there is no evidence of previous damage to your heart muscle

If your doctors were emergently concerned about the findings, they would have performed your cath sooner. I think that the cath is necessary to eliminate your heart as the cause of your discomfort. As you know there are many other causes of chest discomfort.

Lastly, I would encourage you to focus on your risk factors and reducing your risk factor profile. And remember that stress also can contribute to the development of heart related and non heart related chest pain

Good luck

[LeLe1962]

Thank you Dr.

I'm a 45 year old female with hypertension, graves disease, and obesity.  I have been going through a lot of stress lately with the thyroid issue.  I had an RAI to ablate the thyroid which made me crash and become hypothyroid very quickly.  I was very hyper before with PVC's, very high hypertension, and tachycardia.   I was hospitilized twice due to the thyroid but never did storm.   I do not smoke but I use to.  I do not drink or use any drugs.  I stop smoking over 5 years ago.  My cholesterol is very good at 170.  I know that my good cholesterol is great and my bad is low.  I'm just not sure of the exact numbers.  My tryglecerides are at 160.

I've been trying very hard to lose weight and it is very hard.  I know that is a big risk factor for me.  I'm 80 pounds overweight.  

Thank you so much for you answer.

I'm very scared to have the cath even though I've had one before that showed a narrowing in the same place.  I'm not sure if I was born with it or not.

Any other input you could give would be appreciated.

Thanks again :)