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Heart Disease (Expert Forum)
Diagnosis Interpretation
Answered by
Cleveland - OH
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Diagnosis Interpretation
by Al 45, Oct 28, 2004 12:00AM
About a month ago I was admitted to the hospital with chest pains which were later diagnosed as pleurisy. Although initial tests (EKG) indicated that the pain was not caused by the heart, I was admitted to undergo further tests. Before I left the hospital, I had undergone a CT scan of the lungs, a nuclear stress test and an angiogram. The CT scan was ok. The stress test diagnosis stated: “Analysis of the rest and stress SPECT images, as well as bull’s eye and gated reconstruction is performed. The gated images demonstrate inferior hypokinesis with an ejection fraction of 50%. The SPECT images show a moderate to severe inferior and inferoapical perfusion abnormality that is partially reversible. This would suggest nontransmural infarction with residual ischemia in the distribution of the right coronary artery.”
I don’t have a written result of my angiogram; however, the doctor told me that I have a block in the artery at the bottom of my heart with a natural bypass and, since there is a natural bypass, there is no need for correction. He also told me that there is no heart damage and I have no other blocks although there is some “sludge.”
I have searched the internet and found partial answers to my questions. I know what the terms “hypokinesis, infarction, and ischemia” mean, but I can’t put the written diagnosis all together. I just need something in layman’s terms.
1. What does “moderate to severe inferior and inferoapical perfusion abnormality that is partially reversible” mean?
2. What does “nontransmural” infarction and “residual” ischemia mean … have I had a heart attack?
3. Is an ejection fraction of 50% all that serious … I’ve seen both 50% and 55% as minimum norms?
4. Are the stress test results borne out by the angiogram, or vise versa?
5. What is “sludge?”
6. Could the pleurisy have any effect on the tests?
Thanks for your help.
I don’t have a written result of my angiogram; however, the doctor told me that I have a block in the artery at the bottom of my heart with a natural bypass and, since there is a natural bypass, there is no need for correction. He also told me that there is no heart damage and I have no other blocks although there is some “sludge.”
I have searched the internet and found partial answers to my questions. I know what the terms “hypokinesis, infarction, and ischemia” mean, but I can’t put the written diagnosis all together. I just need something in layman’s terms.
1. What does “moderate to severe inferior and inferoapical perfusion abnormality that is partially reversible” mean?
2. What does “nontransmural” infarction and “residual” ischemia mean … have I had a heart attack?
3. Is an ejection fraction of 50% all that serious … I’ve seen both 50% and 55% as minimum norms?
4. Are the stress test results borne out by the angiogram, or vise versa?
5. What is “sludge?”
6. Could the pleurisy have any effect on the tests?
Thanks for your help.
Doctor's Answer
by Cleveland Clinic, Oct 28, 2004 12:00AM
, Oct 28, 2004 12:00AM
al,
thanks for the post.
1. What does “moderate to severe inferior and inferoapical perfusion abnormality that is partially reversible” mean?
A stress test shows the areas of the heart that recieve blood at rest and when your heart is under stress. Perfusion abnormalities are compared between rest and stress to determine if there might be blockages in the arteries that supplies a particular area on the stress test. If there is no flow in an area at rest and stress, it could indicate that the blood supply of that area is closed, if there is flow at rest and not at stress then there could be a blockage causing the finding, if there is flow both at rest and stress then the artery is open. This somewhat oversimplifies things and findings are more of a gradation. WHat your results mean is that you may have had a heart attack (whether you knew it or not) and the area that showns up gets some blood flow. In the setting of your angiogram, it means that your vessel closed, but that the other blood vessels are supplying that area. Under stress those vessels do not fully compensate for the closed vessel. If you have no chest pain, I wouldnt worry about it too much as trying to open a closed vessel is difficult and carries some risk.
2. What does “nontransmural” infarction and “residual” ischemia mean … have I had a heart attack?
See above. Non-transmural means that the entire area supplied by the blood vessel isnt dead. Mural refers to the wall supplied by the vessel. You may have had a heart attack, a large percentage of heart attacks are never known. Either way you should be vigilent about your weight diet and lifestyle to decrease your risk of other problems or progression.
3. Is an ejection fraction of 50% all that serious … I’ve seen both 50% and 55% as minimum norms?
I wouldnt use the nuclear test numbers. They are not as accurate as an echo or ventriculogram during catheterization.
4. Are the stress test results borne out by the angiogram, or vise versa?
Yes, see above.
5. What is “sludge?”
Im not sure. This is not a term used professionally, and he may have been trying to explain something in lay terms. Out of context, I cannot comment
.
6. Could the pleurisy have any effect on the tests?
Pleurisy is often used as a blanket term. Pleurisy refers to irritaion of the lining of the lung and thoracic cavity. Im not sure of the circumstances that you were give this diagnosis and cannot tell you if all the symptoms are related.
good luck
thanks for the post.
1. What does “moderate to severe inferior and inferoapical perfusion abnormality that is partially reversible” mean?
A stress test shows the areas of the heart that recieve blood at rest and when your heart is under stress. Perfusion abnormalities are compared between rest and stress to determine if there might be blockages in the arteries that supplies a particular area on the stress test. If there is no flow in an area at rest and stress, it could indicate that the blood supply of that area is closed, if there is flow at rest and not at stress then there could be a blockage causing the finding, if there is flow both at rest and stress then the artery is open. This somewhat oversimplifies things and findings are more of a gradation. WHat your results mean is that you may have had a heart attack (whether you knew it or not) and the area that showns up gets some blood flow. In the setting of your angiogram, it means that your vessel closed, but that the other blood vessels are supplying that area. Under stress those vessels do not fully compensate for the closed vessel. If you have no chest pain, I wouldnt worry about it too much as trying to open a closed vessel is difficult and carries some risk.
2. What does “nontransmural” infarction and “residual” ischemia mean … have I had a heart attack?
See above. Non-transmural means that the entire area supplied by the blood vessel isnt dead. Mural refers to the wall supplied by the vessel. You may have had a heart attack, a large percentage of heart attacks are never known. Either way you should be vigilent about your weight diet and lifestyle to decrease your risk of other problems or progression.
3. Is an ejection fraction of 50% all that serious … I’ve seen both 50% and 55% as minimum norms?
I wouldnt use the nuclear test numbers. They are not as accurate as an echo or ventriculogram during catheterization.
4. Are the stress test results borne out by the angiogram, or vise versa?
Yes, see above.
5. What is “sludge?”
Im not sure. This is not a term used professionally, and he may have been trying to explain something in lay terms. Out of context, I cannot comment
.
6. Could the pleurisy have any effect on the tests?
Pleurisy is often used as a blanket term. Pleurisy refers to irritaion of the lining of the lung and thoracic cavity. Im not sure of the circumstances that you were give this diagnosis and cannot tell you if all the symptoms are related.
good luck
try starting at 8am on the dot then try 9 am and i posted a question about 3 months ago at 10am eastern time. hope it helps and good luck posting a question!
try starting at 8am on the dot then try 9 am and i posted a question about 3 months ago at 10am eastern time. hope it helps and good luck posting a question!
Any suggestions or comments? I can't seem to get in to post a medical question in the central time zone.
Hi,
Do search on costochondritis or " benign chest wall pain" , also precordial catch syndrome might explain some of your symptoms. I am not a doctor, but I do suffer anklosing spondylitis and suffer costochondritis secondary to this condition.Your symptoms sound similiar to what I experience, having it for 15 years without a major event , one would doubt it is cardiac related. You might have an underlying connective tisssue disease, epsecially if you have "spot pains"(trigger points) areas over your body that the pain is intense when pressure is applied to the area no bigger than the size a quarter( consistent symptoms also accompany fibromyalgia syndromes. You might also find yourself suffering from chronic fatigue at times. These are just some suggestions, it took nearly 10 yaers for my condition to be properly diagnosed.
P.S. try posting between 6 central and 10 central a.m. the window of opportunity is only for about 5 minutes, you basically have keep clicking on post a question every 2 minutes sometimes to get lucky!!
Good luck.
I will definitely check into what you mentioned. Throughout my many visits to the doctors offices and emergency rooms, I keep being told that no one else suffers these same symptoms and they make me feel like it's in my head. I can't imagine why I have to live with this kind of pain that sneaks up completely un-expectedly without warning but always with intense, crippling pain. I don't want to live with this anymore...there's got to be someone who can help or has heard of this happening to someone else. I know that others feel some sort of sharp sensation that sometimes takes their breath away but mine does not go away with another breath...it will linger and like I said, keep me in bed paralyzed until it goes away the next day or longer.
mine keeps in bed for usually a day or 2 also ,but can come and go for weeks , like i said it took 10 years for a proper diagnosis on myself. Good luck and don't give up or give in!