Stress test shows attenuation/perfusion defect apical septum

[autumnwolf]

My doctor ordered the stress test (IV meds only) on Monday.  Wednesday the office called and said the doc wanted me to come in the next day (today, Thursday).  I've got the results, and will get an appointment with the Cardiologist as soon as possible.  I expected to find that nothing was wrong, so I went a kind of daze, and didn't understand much of what my PCP said.  He gave me a copy of the findings, which I am now posting to you!
1.  Mild to moderate in size attenuation/perfusion defect apical septum with near total reversibility.
2.  Mild attenuation/perfusion defect mid to apical lateral wall with total reversibility.
3.  Calculated ejection fraction 58%
4.  Septal hypokinesis.
Now, my PCP did explain that the #2 finding may be able to be fixed with angioplasty.  And they are both reversible, which brings up the question... does this mean a simple little procedure, or actual heart surgury?  (And I know I'm being a big baby about this, but does that mean open heart surgury???)
I would appreciate any info you can give me.  I'd feel stupid if I have to make another appointment just to make him go over the same things again, lol!
Thank you so much,
autumnwolf

[kenkeith]

Thank you for your question, and it is helpful your doctor gave you your report. ...that should be a requirement. Questions:
"1.  Mild to moderate in size attenuation/perfusion defect apical septum with near total reversibility.
2.  Mild attenuation/perfusion defect mid to apical lateral wall with total reversibility.
3.  Calculated ejection fraction 58%
4.  Septal hypokinesis."

Let me give you a perspective that you may want think about and discuss with your doctor. I have a completely blocked left coronary artery for many years and there are other vessels that feed into the area deficit from the blockage.  The phenomonon is a natural  bypass;  condition is called arteriogenisis and that occurs for some people. Also, a 72% circumflex blockage for years.

There are medical studies (link with google COURAGE study) that concludes there are no advantages for the 3 different treatments (medication, stent implant, and CABG). The available therapy only treats the symptoms.  I have been on medication for more than 6 years without any progression or symptoms, and my cardiologist is a non-intereventional cardiologist, the prior interventional cardiologist likes to do stent implants and 6 years ago stented my right side coronary artery...a couple of months later he wanted to do the 72% blocked artery.  A few weeks later he resigned before I could give him an answer...current doc doesn't mention doing a stent implant.

You have a normal beating heart (50-70% EF).  That indicates the percentage of blood pumped into circulation with each heartbeat.  Hypokenises indicates some impairment of heart wall movement of the septum.  That is the wall the separates the left and right chambers.  It is the outer chamber wall that sqeezes the chamber blood against a more rigid septum.  As a consequence the EF is not effected very much hypokinesis.  Also, I had heart wall impairment (hypokensis) and my EF was less than 29% and an enlarged left ventricle. Currently my heart is normal size and no hypokenises and an EF at 59%.  Have not had one day of any illness nor side effects from medication.

The point I am making is that medication may be a good option.  Later if medication does not resolve your symptoms you can go for stent implants. Discuss with your doctor, and keep in mind stents can clot, block again, and there is a small risk with an intervention.  Take care,

[erijon]

These could most likely be handled with stent placements during an angiogram to confirm. I would think they would look a little closer first as they mention attenuation  which means the picture may have been of a poor quality due to the image being taken through excessive soft tissue. However, you do show some hypokinesis which is an impaired movement of the heart muscle itself whch could be caused by a blockage.

What symptoms were you having and why did they order the stress test?

I would doubt that heart surgery is required, an angiogram will confirm the amount of  the blockage and if surgery or just a stent is required.

Good luck,

Jon