abnormal SPECT and borderline echo.. what does it mean?

[omcintyre]

I've been in the process of getting bariatric surgery and needed a cardiac clearance. Cardiologist ran EKG (normal) and echocardiogram which came back as borderline abnormal for asymmetric left ventricular hypertrophy, but with normal dydtolic function, and normal ventricular wall motion. Everything else was normal other than a trace mitral regurgitation. Cardiologist then ordered adenosine stress test, which also came back abnormal (results follow):

Findings: Rotating planar images demonstrate the ventricle to be within normal limits for size. There is severe attenuation artifact.
Stress tomographic images demonstrate moderate to severe reduction in a small to moderate territory of the inferior wall. Resting tomographic images demonstrate a slightly more regular pattern.
Gated data demonstrates normal wall motion.
The ventricular ejection fraction is calculated at 66%.
Conclusion:
1) Technically suboptimal study as described above. There is severe attenuation artifact. This limits the reliability of the findings.
2) Probably abnormal study demonstrating moderate to severe partially reversible change in a small to moderate territory of the inferior wall in a pattern consistent with ischemia.
3) Gated data demonstraes normal wall motion.
4) The left ventricular ejection fraction is calculated at 66%.

The cardiologist has ordered an angiogram (have been waiting for the auth for nearly 3 weeks).

What does all of this mean? I am a 32 year old single mom of a 7 year old. I am morbidly obese with Intracranial Hypertension as well as Rheumatoid Arthritis, sleep apnea, GERD, asthma and several other  annoying issues. I'm on tons of meds, including for long standing hypertension (medications: Toprol XL 50mg qd, Norvasc 5mg bid, plaquenil 200mg bid, lasix 40mg bid, diamox 750mg tid, potassium 40mg bid, prevacid 30mg qd, wellbutrin SR 150mg qd, Singulair qd, proventil inhaler qid, advair 250/50mcg bid, bicitra 15cc tid, fentanyl 50mcg patches)

The cardiologist is telling me NOTHING. He hasn't explained anything, and I am in desperate need of bariatric surgery.

Could someone please explain what's happening, and what it means? Also, what I can expect, or should expect? The cardiologist did say something about stents or possibly bypass if necessary, but they both sound pretty awful for someone my age.

Also, how would this effect my need for surgery, and getting clearance to have surgery?

Thank you.. this is very upsetting and I'm trying to understand what's going on so I can stop freaking out.

Thanks!

[LLWB]

I'm not able to answer a lot of your questions, I'm sure someone more knowledgable than I will reply soon. Just wanted to try to  help you stop freaking out! It's good that they found problems before surgery, you don't want heart problems during the middle of a surgery. I've had the fundiplication surgery for GERD, and no longer had to take prevacid or any antacids. It's not going to affect your need for surgery, but it may affect getting clearance for the surgery. Take a deep breathe, relax, and tell yourself that knowing you have a problem is better than not knowing. I'm waiting for an echo on Nov 8th, and nuclear stress on Nov 11, but the kicker is not going back to dr until Nov 29th for results. Doctors and insurance companys don't seem to realize the stress they put people through, by not handling things in a timely fashion. The cardiologist probably can't tell you anything until you have the angiogram and they can tell in more detail what your problems might be. Good luck, please post results when you do get them. Try not to worry too much in the meantime.

[erijon]

The main issue is item # 2 under the conclusions. The test shows an area of your heart that is not receiving an adequete supply of blood during exertion which would indicate an area of blockage in one or more of your arteries. The reason for the cath is that there is significant attenuation which means the pictures may not be clear due to a large amount of soft tissue. This is most likely due to your excessive body fat. They need the cath to validate the stress test because they could see an area of your heart at rest and under stress where there was a difference in the amount of tracer taken up by your heart muscle in that one particular area compared to the rest of your heart muscle that was visable.

Mine showed everything was normal but did also mention some diaphramatic attenuation which simply meant my stomach fat abscured part of the pictures, but it only blocked a very small area of my heart and it was the same at rest and under stress with no changes in my ECG, wall motion or chamber function which was enough to rule out a blockage. Fortunately I have lost 70 pounds this year and and getting closer to an ideal weight. Unfortunately, in your case they were able to see an area of your heart that did show a change at rest compared to when it was under stress. When they mention it was deemed reversable, they feel it can be treated either medically or surgically, either by inserting stents to open up the blockage or by doing bypass surgery. I seriously doubt that you will be abe to find a surgeon willing to do your bariatric surgery until this is resolved, but that is just my opinion.

The doctor won't really have anything to say until the cath so they look and see if you have any blockages. I know it's no fun, but you'll just need to tough it out until the cath, they won't have any more info until then.

Good Luckl!

Tony