My Nuclear Stress Test Results - Heart Cath??

Approx a year and half ago I began noticing some swelling and edema around my ankle areas. I'm a 34 year old male, 6'1 and 179 lbs, I don't smoke, no drugs, rarely drink, and I eat a diet that's somewhat healthier than the average American diet. I'm generally a healthy person aside from having moderate scoliosis. (30 degree curve)  For as long as I can remember (since my teens) I've always seem to have rather poor circulation in my legs and feet. My toes would seem to always tingle and my feet would always have the tendency to turn red or even purple, when sitting down for any length of time. I'm a web designer, so unfortunately my job requires that I sit down for most of the day. My mother (who also has scoliosis) has always suggested that such symptoms were due to the spine compressing on nerves, etc, and that any chest wall pain is probably related to having scoliosis. I also have acid reflux, however I know the difference between acid reflux pain, and this other chest wall type of ache pain.

What prompted me to finally go see a cardiologist a year and a half ago, was my father. He passed away 4 years ago from having his heart just "stop" in his sleep at the age of 51. However, that being said, it should be stated that my father heavily abused drugs during much of his life (cocaine, marijuana, and especially pain killers.)  Regardless, since that time, I began fearing that I may have some type of "hidden" heart problem or disease.

The visit to the Cardiologist:
One night while taking a brisk walk, I felt the normal "tightness" feeling I usually have. Out of worry, I simply decided to go straight to the ER just to have them check to make sure everything is ok. I was checked in, and they ran a blood test, extended ekg, took a couple of normal chest x-rays. Everything came back normal and I was discharged with a referral to a cardiologist for follow up. I went to the cardiologist for further testing. The doctor did a resting echo, ekg, and the standard stress test on a treadmill. Everything came back normal. He then decided that as an effort to eliminate any concerns, that I should do a nuclear stress test. I went ahead with the nuclear test, and immediately after, he said that there are few concerns with some of the images that came back which reveled possible ischemia. I was really surprised, seeing how up until now, everything else was normal. He then said "I think for peace of mind, you'd be best going ahead with a heart cath just to rule anything out." Knowing how invasive that would be, I said "ok let me think about it" Even more of a concern was the amount of radiation used during a heart cath. (Radiation is a HUGE concern of mine, because during this same time period, I had to have two full abdominal ct scans ordered by Gasto Doctor, prior to him finally diagnosing me with acid reflux.) So having just done a nuclear stress test (which uses roughly 8msv of radiation) he was then wanting me to do a heart cath. Needless to say, I declined and decided to go on with my life. A few weeks later, I called the doctor's office to get the final report of my nuclear stress test, and below is what it said:

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Perfusion SPECT:
Stress images revealed a small, mild, and fixed area of decreased tracer uptake in the apical wall, a normal finding. Stress images revealed a small, mild, and fixed area of decreased tracer uptake in the inferior wall. The rest images revealed a fixed area of decreased tracer uptake in the inferior wall. The reduced inferior wall uptake appears to be related to the diaphragmatic attenuation.

Gated SPECT:
The gated SPECT images revealed a normal left ventricular thickness and wall motion with an LVEF of 51%.

Conclusion:
Stress images revealed a small, mild, and fixed area of decreased tracer uptake in the apical wall, a normal finding. The rest images revealed a fixed area of decreased tracer uptake in the apical wall. The gated SPECT images revealed a normal left ventricular thickness and wall motion with an LVEF of 51%.

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Judging from the above mentioned test results, why would he recommend the more invasive heart cath, given everything else that was mentioned? The reason I'm just posting this now, is because the aforementioned symptoms are still persisting, with the addition of new leg pain in my thighs, after sitting for extended periods of time. I eagerly look forward to your input, advice, and comments. Thanks!

[erijon]

The test does show that you have some areas of reduced profusion which could mean that you have some blockages in your arteries. Even though this states it is "normal finding" (normal varient", I reall doubt the statement of diaphragmatic attenuationas which means the image was reduced due to an enlarged left side of your diaphram and given your heigth and weight, I dopn't see that being too possible.

If you are still having pain the responsible thing to do would be to have a cath and make sure this test is a false positive, it's not worth taking a chance. I would do it in a minute.


Hope this helps, good luck.

Jon

[Eccentric Guy]

Hi erijon, thank you for your response to my post. So you're opinion that diaphragmatic attenuation isn't the likely cause, even though the final report actually states this by the doctor himself? The reduced intake was seen in both rest and under stress. Seeing that I have scoliosis which has noticeably shifted my rib cage, I think I'm going to disagree with you on that. I do know that nuclear stress tests are proven to generate high false positive in younger patients which have lead to a high number of unnecessary heart caths. One important fact I forgot to mention, is that that I had some scar tissue of the chest area during the stress test, due to a recent gynecomastia surgery. So, I'd really love to hear what a doctor's opinion about this, here within the forum.

[erijon]

I certainly understand your thinking, I'm just giving my opinion. Perhaps your shifted rib cage may be the issue, but diaphragmatic attenuation is usulally a finding when testing obese patients in which the diaphram muscle and surrounding fat obscures the image. Again, if it were me and I was still having symptoms after a positive stress test, I would have a cath in a minute. Also as I'm sure your doctor pointed out, your EF is on the low side supporting the findings. Plus you do have a family history, maybe it was your father's life style that caused his problems or maybe it runs in the family,  no way to know. The fact that a Nuclear Stress test does have a higher rate of false positives is the reason your doctor wants to do a cath to rule out heart disease, seems pretty reasonable to me.

Unfotunately, you won't get a doctor to answer on this forum, this is a forum of people like you and I that is here to support those who need it. You should try to post a question on the expert forum, it can be tough as they only take 2 questions a day, but keep trying as the opportunity to post roatates by time zone so keep trying.

Good Luck, I truely hope it works out for you!

Jon