Dad's stress echo

Hello,
My Dad is 66 yrs. old.  He is about 25 lbs. overweight, is on medication for high blood pressure and has a family history of heart disease (his Dad died from a massive heart attack when he was in his early 60's). Recently my Dad had an Ekg.  I am not sure what all of the results mean.  He has not been seen by a cardiologist, only his family practitioner. Can you tell me what the stress test indicates, and whether he should have any follow-up?

Here are the results:  Multiple planar images with tomographic reconstructions were obtained at stress and rest.  There is no evidence of LV dilation with stress to indicate cardiac decompesation.  Some patchiness of activity is seen throughout the LV wall, most prominently seen at the apex and extending slightly into the adjacent anterior wall.  These findings do not change significantly between stress and rest.  No focal area of diminished activity is identified at stress or rest to indicate ischemia. The gated SPECT study could not be performed secondary to difficulty with the triggering mechanism.

IMPRESSION:  Based on images, this stress cardiac study demonstrates no focal evidence of stress induced myocardial ischemia.  The diminished activity at the apex extending slightly into the adjacent anterior wall may in part be related to some apical thinning or previous myocardial infarction.

Thank you for reviewing these results.  My Dad's doctor isn't very good about communicating with his patients and I want to make sure my Dad is receiving the best and most thorough care!

Janelle

[Cleveland Clinic, MD]

Dear Janelle,
The test your dad had is called a SPECT thallium exercise stress test.  This test works by injecting a nuclear 'tracer' that travels through the blood to the heart at rest and then again at peak exercise. The individual then lays under a camera that is able to detect this tracer in the heart both before and after exercise.  A picture can be made and this is then interpreted by the doctor. If there are areas of the heart that have been damaged by previous heart attacks they will appear as dark areas on both the rest and stress images. Areas of the heart that have blockages will appear dark only with the stress images.

Sometimes there can be 'false positives' and 'false negatives' and that is why a doctor must decide what the picture is showing.  The wording of the report is written in a way to try to communicate what the nuclear doctor feels the images show.

Essentially what this report is saying is that there is no evidence of ischemia (blockages) but there are changes that may suggest a prior heart attack.

[janelle]

Based on these results, should he be followed by a cardiologist and have further evaluation?  If he does not have blockage, what could have caused the heart attack?

[Jimt7]

A related discussion, Positive stress test was started.