stress test results

[svc1012]

My husband is 66 and recently had a SPECT Myocardial Perfusion Imaging Study (stress test).  It was essentially normal, with the exception of the following:  "there is a moderate sized reversible defect of the inferior and apical walls".  The left ventricle was normal in size and the ejection fractions were 57% at rest and 63% post stress.  The internet resources suggest that such a defect could be indicative of a prior silent heart attack.  Is this true?  Are there any other possibilities?  What is the treatment?

[Flycaster305]

Ed34's suggestion is spot on.  An angiogram is the 'gold standard' to determine if a blockage exists, and if it can be fixed with a stent, or if bypass surgery is necessary, or if collateral arteries are developing naturally to 'light up' the area of the heart.

It will be interesting to hear what the angiogram finds, especially if his EF factor remains in the normal area. It could be that he has 'stunned' heart cells, which means they aren't dead, and can be revived with exercise and good drugs.   In this case, he may need a stent that might lead to a revitalization of the lower heart region, but certainly he is very fortunate, he has received a big warning that he has some heart issues.  I got the same  type of report a number of years ago, and I made changes.  I've had additional cardiac adventures, but I'm still standing and active.

The initial report supports that he had a silent heart attack, but his EF is very strong.  I'm thinking he has been given a very strong warning but will be fine as long as he takes the good drugs, exercises, etc.  Keep us informed.

[svc1012]

Thank you very much.  The PA from the cardiologist's office called late yesterday and said that there was an area in the lower part of the heart that did not light up the way it should have.  He is having an angiogram/cardiac catheterization with possible insertion of a stent on Friday.

[ed34]

I think reversible means that they feel the problem is not due to dead heart muscle from a heart attack. Usually reversible means that there is blood getting into the muscle, but not enough under stress. When they do a perfusion scan, they normally do one at rest, and one with the heart having been worked harder and Nitro to open the arteries. So, if there is a defect showing at rest, then this would more than likely be scar tissue. But if it looks bright on the scan at rest, but duller after stress, then this would normally indicate a partial blockage, or perhaps a total blockage being bypassed by some collaterals. The only real way to determine the situation now would be an angiogram.