Nuclear Stress Test Results

[Ellen1953]

I had a nuclear stress test & they found "mild ischemia in the inferior apical area" with an ejection fraction of 75%-I am symptomatic with angina and SOB & take toprol xl and imdur but still have some symptoms-what does the stress test mean in laymans terms-thanks

[kenkeith]

I was in ICU for congested heart failure that came about very suddenly without any symptoms prior.  Given blood test, chest x-ray, EKG, echo and then a cath angiogram.  The diagnosis was very little blood flowing to the distal portion of the heart.  It was believed if the 98% blocked RCA was stented there would be more blood to that portion of the heart.   The 100% blocked LAD had developed collateral vessels for a natural bypass, and circumflex is 72% blocked (no stent).

It has been about 5 years, and with medication, there are no symptoms and my heart is normal size and functioning normally.  The heart cells that appeared to have been damaged (hypokinesis) were hibernating, but mitral valve regurgitation remains.

A few months ago I had CT scan 64-slice angiogram.  As expected I have CAD.  A scan would be beneficial for you as you have a family history of heart disorders.  The scan has images of the vessel anatomy and thqt includes the area between the inner lining of the vessels and the outer layer.  Soft plaque can buildup in that area and rupture through to the lumen causing a clot that can be dislodged and cause a heart attack.

The cath angiogram only has images of the lumen, and the plaque that develops there causes ischemia (lack of blood flow) and angina (chest pain).  Less probability of any heart attack, but the insufficient blood/oxygen flow over a period of time can damage heart cells and then heart failure.  Angina is a warning that the heart is not receiving enough blood/oxygen.  If medication relieves angina that indicates almost always the coronary vessels are dilated sufficiently enough to prevent any heart damage.  If medication does not relieve the angina, then a stent to prevent heart cell damage.  

[Ellen1953]

Hi Ken-thanks for responding-have you had an angiogram? My cardiologist put me on im (time released nitrates) in addition to the toprol xl (beta blocker) & said if the angina & SOB continued he wants to do an angiogram-if you did have an angiogram how did they decide when to do it? Thanks for everything-I am a born worrier & this is really bothering me-my Dad had a heart attack at age 43 & I am 55 so I am worried I will follow in his footsteps

[kenkeith]

Mild ischemia (reduced blood flow) to the area stated.  When one excercises (or under stressful conditions) the heart requires more blood oxygen, and almost always the problem is due to narrow coronary vessels caused by some blockage causing chest pain (angina).

Your heart is pumping a normal output so that isn't contributing to the ischemia. Normal EF is 55-75% and that is the amount of blood pumped out with heartbeat.  If medication doesn't control your angina you may require a stent(s).  You option is to increase your medication, change medication, or intervention (stent or bypass).  I don't have angina with medication,and I have 100% blockage and another with 70% blockage