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Heart Disease (Expert Forum)
Scar on left ventricle
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Scar on left ventricle
by Bodoni, Dec 29, 2000 12:00AM
I have posted before, but need a follow-up.
I am a 57 year old male and have had a Left bundle branch
block for at least 4 years. I do have a family history of HD.
I had a echo-cardiogram last winter that was negative.
I had some PVC's or 'skips' and 'pauses' this fall and was given
a 24-hour Holter, a chest x-ray, ECG and heart related blood enzyme tests. All were normal. Of course, I understand that a
L-BBB can confuse, mask or alter the outcome of an ECG.
In early December I had a stress/treadmill test with Thallium Nuclear Scan[s]. The results were positive and/or inconclusive. The doctors said because of my L-BBBB, it may have been a false
positive and wanted to re-do the test. I agreed, but this time they used Adenosine instead of the treadmill.
Then I was given the 2 Nuclear Scans, about 2 1/2 hours apart,
just as I had done in early December.
These results indicated that the larger defect that was present on
the earlier Treadmill/Thallium scans was NOT evident. So, this
was good news.
However, it has shown a 'small' scar on the lower left ventricle.
My doc says this could be from an old 'silent' heart attack. He
did stress that the defect or scar was small.
My questions are:
1. Are the odds in favor of an old heart attack? Or what other
reasons could cause this scar to be there?
2. Is there a chance, because of my L-BBB, that this could indeed
just be a false-postive? [ I understand that Nuclear Perfusion
Tests - especially with L-BBB's - can produce results that mimick
heart attacks. ] Is this true?
3. Is Persantine a similar drug as Adensosine? If not, what are
the differences?
4. My total Cholesterol was 199. LDL, 129 with HDL at 48.
My doc thinks I maybe should go on Lipitor. Would you agree?
5. Also, my doc thinks one Baby Aspirin per day and starting
a 25 mg. dose of Atenelol would also be a good way to go.
Would you agree with this?
6. He also thinks a mild cardio exercise program along with
a very low-fat heart diet would be okay with the above test
results. Would you think this is prudent as well?
7. And finally, do you think I have had enough testing for
the time being?
Thanks for your time and attention. And have a Happy New Year!
I am a 57 year old male and have had a Left bundle branch
block for at least 4 years. I do have a family history of HD.
I had a echo-cardiogram last winter that was negative.
I had some PVC's or 'skips' and 'pauses' this fall and was given
a 24-hour Holter, a chest x-ray, ECG and heart related blood enzyme tests. All were normal. Of course, I understand that a
L-BBB can confuse, mask or alter the outcome of an ECG.
In early December I had a stress/treadmill test with Thallium Nuclear Scan[s]. The results were positive and/or inconclusive. The doctors said because of my L-BBBB, it may have been a false
positive and wanted to re-do the test. I agreed, but this time they used Adenosine instead of the treadmill.
Then I was given the 2 Nuclear Scans, about 2 1/2 hours apart,
just as I had done in early December.
These results indicated that the larger defect that was present on
the earlier Treadmill/Thallium scans was NOT evident. So, this
was good news.
However, it has shown a 'small' scar on the lower left ventricle.
My doc says this could be from an old 'silent' heart attack. He
did stress that the defect or scar was small.
My questions are:
1. Are the odds in favor of an old heart attack? Or what other
reasons could cause this scar to be there?
2. Is there a chance, because of my L-BBB, that this could indeed
just be a false-postive? [ I understand that Nuclear Perfusion
Tests - especially with L-BBB's - can produce results that mimick
heart attacks. ] Is this true?
3. Is Persantine a similar drug as Adensosine? If not, what are
the differences?
4. My total Cholesterol was 199. LDL, 129 with HDL at 48.
My doc thinks I maybe should go on Lipitor. Would you agree?
5. Also, my doc thinks one Baby Aspirin per day and starting
a 25 mg. dose of Atenelol would also be a good way to go.
Would you agree with this?
6. He also thinks a mild cardio exercise program along with
a very low-fat heart diet would be okay with the above test
results. Would you think this is prudent as well?
7. And finally, do you think I have had enough testing for
the time being?
Thanks for your time and attention. And have a Happy New Year!
Doctor's Answer
by CCF CARDIO MD - DLB, Dec 29, 2000 12:00AM
1. It could be an old heart attack.
2. Yes it could be a false positive.
3. Yes, similar effects.
4. Yes.
5. Yes.
6. Once there is a possible abnormality identified, I usually recommend a cardiac catheterization before advising on an exercise program.
7. This is a difficult question. If you were not having any symptoms, I may not have favored any testing to begin with. Now that you have had so much testing with discordant results, I would do a definitive test - cardiac catheterization.
2. Yes it could be a false positive.
3. Yes, similar effects.
4. Yes.
5. Yes.
6. Once there is a possible abnormality identified, I usually recommend a cardiac catheterization before advising on an exercise program.
7. This is a difficult question. If you were not having any symptoms, I may not have favored any testing to begin with. Now that you have had so much testing with discordant results, I would do a definitive test - cardiac catheterization.
