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Question about Ischemia
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Question about Ischemia


  Hi, would you please tell me what apical and distal septal ischemia means? Is a Treadmill Stress Thallium Study dependable or would you recommend another test to confirm? Is it something to be concerned about and what should be done after this diagnosis is made? Thank you.
  Allie
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Dear Allie,
The heart is divided into arbitrary segments in order to correlate blood flow from the
coronary circulation to particular walls or segments of the heart.  Hence  the cardiologist and or
radiologist can correlate a particular abnormality on the thallium to disease
(coronary blockage)in a particular coronary vessel.  There are 16 segements in general,
6 at the base of the heart, 6 at the mid-level, and 4 at the apex or tip of the heart.
These segments actually are segments of the left ventricle (the pumping chamber of the heart) and
not segments of the 'whole heart' which includes four separate chambers.  
If you imagine the left ventricle to be shaped like a bullet, the base is the flat or back part
of the bullet and the apex of the heart is the tip of the bullet.  And the mid is the mid of course.
The walls of the left ventricle are the septal, the anterior-septal, the anterior (front wall),
the posterior, the lateral and the inferior wall. Your abnormality is in the distal or apical portion of the
septal wall-essentially one segment-and lo and behold the one segement that is most likely to give you a false
positive reading-especially in a woman.  In other words the thallium is not a 100% for sure test, rather it is
part of a whole evaluation which includes the ecg portion of your stress test, and most importantly the cardiologists
opinion as to what your true overall risk is of coronary artery disease.  For instance, if your risk for coronary artery disease is high,
and there are subtle abnormalities on the thallium that could very well be false positive results (false positive means that the test says you have disease when really you do not)
but the doctor will probably send you for a cardiac catheterization (a procedure whereby contrast is injected in to the coronary arteries to look for blockages.)
If your risk is low, and the thallium shows what is likely a false positive test and you had NO ecg changes or pain with the stress portion of the test, then the doctor will likely chose
follow up with or without medical therapy (medications.)
So you see that it is not so simple, and there is a reason why we physicians train for so many years. Your doctor should discuss not only the results of the test s/he ordered but also the
plan from this point on with the reasoning behind it and any precautions and lifestyle changes you might make to improve or maintain your health.
I hope that this information has been useful for you, please write back with any further questions.
Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment can
only be made by your physician(s).




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