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Understanding cardiac report
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Understanding cardiac report

The following is on my Dad's report but the doctor has not explained this very well.  Could you please explain what is going on and how serious this is?

The patient underwent a Lixiscan Cardiolite revealing medium, moderate to severe, anterior apical, fixed defect, as well as a small, mild to moderate inferior, partially reversible defect.  Ejection fraction was estimated at 55%.  Patient denies chest pain, palpitations, presyncope, orthopnea, or significant lower extremity edema.
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There is a medium sized, moderate to severe defect in anterior and apical wall that is fixed suggestive of infarct.  The is a small mild to moderate defect in inferior wall that is partially reversible suggestive of infarction with minimal peri-infarct ischemia.

Lungs reveal diminished breath sounds bilaterally, but no frank wheezes or rales.  Heart: Without murmur, normal S1 and S2.  There is no S3, S4 or rub.Apical impulse is normal.
***
We think maybe he has had a silent heart attack at some point.  Is his heart function compromised? (moderately, severely? etc)  Any help would be appreciated.  Thank you
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159619_tn?1318997813
Your father has experience an MI at some point which is indicated by the comment "There is a medium sized, moderate to severe defect in anterior and apical wall that is fixed suggestive of infarct". He also has another area with a partially reversible defect which may be treated with meds or a stent depending on the severity. The good news is that his heart is still functioning well with a normal EF% of 55% which represents the amount of blood pumped out of the left ventricle with each beat.

Have his doctors recommended any treatment options yet? He sounds like a candidate for an angiogram to see exactly what kind of shape his arteries are in.

Let us know,

Jon
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367994_tn?1304957193
Almost always a stress test is given when the individual has symptoms and that usually is chest pain.  The chest pain is the result of insufficient blood supply to heart cells and that would indicate oxygenated blood is not adequately supllied to the heart cells.  Your father appears not to have any chest pain and that can be the result  "silent ischemia"....meaning there are no symptoms, but there is a lack of sufficient blood flow!!
But that can be ruled out because your father's heart is pumping effectiovely.  

It appears your father may have had a silent heart attack, and that would explain the infarct (necrotic heart cell, dead)...if true.  But a good EF indicates the heart has sufficient contractility to pump adequately.  I had exactly the same situation 7 years ago and I had had a slilent heart attack, and my first symptom was heart failure (EF below 29%), enlarged left ventricle, pulmonary edema as the heart wasn't strong enough to pump the amount of blood received into circulation and the blood backed up into the lungs causing hyperventilating, dry cough, shortness of breath and fast heart rate.

If your father has had some heart cell damage as the report seems to indicate, your father should have an echocardiogram.  The echo will show if there is any heart wall movement impairment (some loss of contractility).  My echo showed hypokinesis (heart wall movement impairment),  Also, the echo will measure the heart's wall and chamber sizes...if the heart is enlarged from a silent heart attack  that could indicate a more advanced condition.  The echo will answer your questions: had a silent heart attack?  Heart function compromised and if so to what extent?

Hope this answers your questions and if you have any furthere questions or comments you are welcome to respond.  Thanks for sharing, take care.

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Avatar_n_tn
Your answer was very thorough to the other person and I would like to get your feedback on my info from both the echocardiogram and stress test if you would not mind.

* a right ventricle that is borderline dilated

* the left atrium is borderline dilated

* trace mitral regurgitation

* trace tricuspid regurgitation

* my LVEF was at the borderline level of 75%

* small, mild proximal wall defect involving the anterolateral wall and extending from the apex to base

* mild lateral hypokinesis proximally

* small, mild proximal lateral infarction with peri-infarct ischemia extending into the anterolateral wall

* my EFE is >60%

I realize everything is either mild, or borderline, or not too bad but there are several things anyway.  The reason why I had all this done was because my heart palpitations have gotten worse and more frequent over time to the point of taking my breath away, and I have had a couple episodes where I had chest pains and got really dizzy, sweating, and feeling nauseated.  So I had the echo done and then they put a heart monitor on me but in the 24 hours I had no episodes.  So then they did the stress test and wanted to do an event recorder but right now do not have any to issue out.  I would really be grateful for you comments and I thank you.
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976897_tn?1379171202
An echo is not the greatest test for accurately determining the EF, far from it. You do realise this report suggests an infarct? They are saying you have had a heart attack at some stage which has destroyed some heart muscle and the per-infarct (muscle directly surrounding this) is ischemic (short of blood). I think the next step is further investigation into the blood vessels such as an angiogram and probably a Nuclear scan would be beneficial to show the extent of the damage more accurately. The borderline dilation could be a side effect of the rest of the heart muscle compensating for the damage. Don't assume that a high EF means everything is fine. Even several blockages in the vessels can show a normal EF. If looks like you may have a blockage which needs dealing with to help the muscle around the necrotic muscle to obtain more oxygen.
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