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Stress Test Results
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Stress Test Results

I had a heart attack in 1997 and had triple bypass surgery.
I also have COPD. I just recently had a stress test with Myocardial Perfusion Scan and need someone to explain the results in terms that I can understand.

The short axis reveals a dilated left ventrical with a mild to moderate decreased uptake of Cardiolite involving the inferior septal and inferior apical wall without redistribution. The vertical axis reveals a moderate defect involving the mid anterior wall but there is decreased uptake of Cardiolite involving all of the myocardial segments. There is no significant redistribution. The horizontal axis reveals thinning of all the myocardial segments with decreased uptake of Cardiolite involving the inferior apical and lateral wall without redistribution. The left ventricular function is 39% with an akinetic mid anterior, basl inferior and apical wall with diffuse global hypokinesis.

Overall, there is evidence for a dilated left ventricle with thinning of all the myocardial segments with areas of decrease of viability specifically the inferior septa, inferior apical, mid anterior and the whole inferior wall.  There is no significant ischemia in this study.  The left ventricular ejection fraction is 39% with diffuse global hypokinesis and an akinetic mid anterior, basal inferior and apical wall.

Also, when having heart surgery, the doctor said my lungs were exploded, what did that mean?
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Dear djis,

I am sorry to hear about your medical problems and hope you are doing well. During the time you were having heart surgery a doctor told you that your lungs were exploded. I don't know exactly what that means, however people with COPD such as yourself can have hyperinflated lungs. Hyperinflation is where the lungs are expanded and appear larger than normal on a chest X-ray.

The findings you mention in the first paragraph describe blood flow in specific areas of the heart.  The short axis, vertical axis and horizontal axis are different planes or cross sections of the heart taken by the nuclear medicine camera. These different plains allows each segment of heart  to be evaluted for the presence of a prior heart attack or evidence of decreased blood flow which would suggest a blockage in heart artery.  The study shows that your heart muscle is weakened. The normal ejection fraction is greater than 55% and yours is 39%. The ejection fraction is the percentage of blood pumped out of the left ventricle during each heart beat and the left ventricle is the main pumping chamber of the heart.
The report states that there is thinning of all the myocardial segments with decreased viability in certain areas. This suggests that you have had prior heart attacks in many areas of the heart.  
There is no signigicant ischemia. This finding suggests that the areas of the heart not damaged by a prior heart attack are currently receiving adequate blood flow.
Diffuse global hypokinesis and akinetic mid anterior, basal inferior and apical wall. This suggests that the overall function of the heart is weakened as previously stated. The regions listed are specific areas of the heart damaged by prior heart attacks.

However,with the above in mind, it is possible that some of the areas of the heart listed as being damaged could actually be functioning poorly due to a chronic decrease in blood flow (hibernation).  I think it would be a good idea for you to have a PET scan. This test  evaluates the heart for hibernating myocardium (heart muscle), which is where certain areas of the heart function poorly due to a chronic decrease in blood flow. If blood flow is increased to these areas via bypass surgery or stenting, the heart function may improve. I would recommend seeking a second opinion from a university based medical center with a PET scan. You maybe a candidate for revascularization (improving coronary blood flow) based on this test.  You can learn more about this test from our website at www.ccf.org.

If a PET scan is not an option, your doctor may choose to treat you based on the above results. Accoring to the above information the areas of the heart not damaged by prior heart attacks are receiving adequate blood flow. I would ask your doctor about amount of viability in certain areas. Viability means that areas of the heart are viable, but may not be functioning normally. These areas   could  improve  with increased blood flow.

People with the findings you have mentioned should be on each of the following medications if they can tolerate them: beta blocker, aspirin, ACE inhibitor and a statin. Discuss this with your doctor, hope this helps.

Thanks for your question,


CCF-MD-KE
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