Irreversible perfusion defect

[EdwardK]

My brother is 61 years old.  In the past 2 month, his heartbeats frequently skipping.  Smokers for 40 years, recently quit.  Has type II diabetic for 15 years.  ECG last month showed SVES, RBBB. This week he has stress test with dipyridamole protocol, and injection of thallium-201.  The result showed "evidence of mild, small to medium size, irreversible perfusion defect in the inferior/inferolateral wall (mid to basal level)."  Could you explain what this means?  Does he need to have surgery or pacemaker?  thanks in advance for your help.   EdwardK

[kenkeith]

The stress test involves imaging perfusion of the injection under different circumstances.  The objective of the test is to determine heart muscle viability at the heart cell level.  

Myocardial viability is based elementry cell function that includes cell membrane integrity (fibers, etc.) and/or preserved intermediary metabolism. Lack of both or one is considered a marker of cell necrosis.  Mild to moderate irreversible defects represents viable myocardium.

Inferior/inferolateral wall (mid to basel level) is the location of interest.

Skipped heartbeats are common and usually not problematic in a medical context.  ECG (EKG) requires further testing as it can be easily distorted by diet, medication, etc.  It is not posible to determine if a pacemaker is warranted without more information, but medication can be beneficial for arrhythmia.  If RBBB is not controled with medication, then ablation (destroy unnecessary electrical pathways) is an option.  That can be accomplished with cath...intervention but not surgery.