ischemia, angina and myocardial defects

[sader1234]

47 yo male, hx of CAD and MI at age of 39 with stent placed in pda (8/03). In (7/05), Nuc study revealed small area of ischemia and global hypokinesis in inferior wall. Now, 12/2010- EF of 48 percent with inf wall hypokinesis to akinesis. Data demonstrates large inferior wall perfusion defect which is predominately fixed. There is a small amount of reversibility at edges, in particular, inferolateral and inferoseptal wall that may be consistent with peri infarct ischemia.
Symptoms currently: shortness of breath with 1 flight of stairs, carrying groceries, mid thoracic back pain at
   rest (more frequent/intense) since MI, fatigue, with challenges getting through the work day because of fatigue.
scheduled to see cardiologist. cath has been recommended by cardiology friend.
? bypass surgery for RCA-

[kenkeith]

Your EF is just marginally low (normal 50 to 70%), and should not be the underlying cause for shortness of breath, fatigue, etc.  I am surprised to see your EF is so high when the report indicates hypokinesis (impaired wall movement) and that usually indicates a possiblility the heart cells are not functioning well and existing on a low oxygen level (possible to revive with good blood supply to the area.  Akinesis indicates the heart cells are dead.

A cath could open a vessel that could feed more oxygenated blood to the area of hypokinesis and that would increase your EF if effective....but you don't have a low EF??
Your symptoms indicate a low cardiac output, but the test indicates 59% of the blood received is pumped into circulation.  A low cardiac output can be occur if there is a reduced volume of blood received from the lungs.  That is the only condition I can think of to explain your symptoms as related to the heart.

You should ask your doctor to explain why you have almost normal EF, but have symptoms of a low cardiac output?  Does your friend have an explanation for a cath procedure.