Fixed anterior apical MI

After lexiscan cardiolite test the conclusions were fixed anterior apical MI, cannot rule out age undetermined MI. Findings on perfusion images were fixed anterior apical hypokinesis. I have to decide whether to have more test to see if the left bundle branch block test that was abnormal needs a stent or to see if there is heart disease.  I can hike for over 2 hours without pain and the only other problem I have is High blood pressure that has been very difficult to control.  Any thoughts about further tests would be appreciated.

[kenkeith]

Your report indicates you had a medicine test rather than the usual exercise (exertion) test.  At the location noted it appears there is blockage of blood flow that impairs the heart wall movement.  Possibly there was a prior ischemic heart attack (MI) from lack of sufficient blood flow.

For some insight..." in general, the diagnostic accuracy of the standard EKG stress test is about 68% and may therefore provide limited information.  This accuracy is further diminished in some patients because of certain medications and/or abnormalities on the resting EKG, etc.  The more sensitive Cardiolite test is useful in these instances and provides what we call a physiologic assessment of blood flow.  In addition, the Cardiolite test provides very useful information about your risk of having a heart attack.  Although no test will always provide 100% accurate information, the presence or absence of a significant blood flow problem to the heart muscle can usually be documented with this test".

If you don't have any symptoms and the evaluation is correct regarding prior MI, the damage is slight and in a location where heart wall movement (hypokinesis) is not of much concern.  An echocardiogram would help determine the significance.

I am somewhat puzzled how an EKG can provide the information regarding hypokinesis, etc. The EKG is an appropriate test for tracing electrical impulses and apparently there appeared to be some blockage in the pathway of the signal, and if blockage is partial it may not be of much concern, but a totally blocked pathway may or may not be a medical issue.

An echocardiogram can evaluate the heart's ability to effectively pump blood into circulation taking into consideration the hypokinesis that impairs heart wall movement.  

Thanks for your questions, and if you have any further questions or comments you are invited to respond.  Take care,

Ken

[Judy7924]

Thank you for your advice.  I had an echocardiogram and a second opinion this morning and the Dr. will do a catherization next Thursday.  I also had a blocked renal artery 10 yrs. ago and he wants to see if that could be the cause of my HB not being controlled. Thank you again for your reply.
Cheers,
Judy

[kenkeith]

Thanks for the response, and I wish you well going forward.  

Ken