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nuclear stress test
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nuclear stress test

I am 60. Did an exercise  nuclear scan. Result: resting cardogram normal. Hr 61bpm.blood pressure 130/80mmhg. Minor st-t changes on ecg. Exercise on bruce protocol 8 minutes, reaching max worload of 10mets. Max hr 140bpm. Max bld pressure 170/80mmhg. No angia. No ischemic changes. No arrhythmias. What does this mean? How can a lay person understand this language. Help me understand.
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63984_tn?1385441539
Your best bet is to talk to your doctor.  Also, you can request the procedure report.  Words like 'no', and' minor' are very good terms,  Ask your doctor, but I'd bet you have a healthy heart.
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Avatar_m_tn
Why did they have you take a "exercise nuclear scan"?
Nuclear profusion scan.

Was there something the doctor noticed earlier in another test?
Normally you don't send 60 year old patients in for such a test unless there is some indication of something unusual.

Had  you had angina at times before?   When?   Under what circumstances?   Had you taken a prior standard ecg treadmill test without the radiation scan?

Your test results appear normal,  though I wonder why they stopped the test where they did?
Were you exhausted,  at the end of your limit?
Actually they took you to the prescribed 85% of "calculated" maximum heart rate for your age,  but since maximum heart rates vary from person to person,  only taking a individual to 85% of  calculated maximum heart rate can give a false impression if your actual maximum is significantly higher than the calculated maximum.

Anyway,  were  you feeling good and able to go longer when they stopped the test?  Or were you near the end of what you could do?

Your 10 mets  is a fairly good sign that  you don't have a serious problem right now.   But see what the doctor says.
Ask him/her why you were sent for this test?   You get a fair amount of radiation from such a test, such that they should have a good reason to send you in for one.

Perhaps there are issues you didn't mention, such as prior instances of angina?
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Avatar_n_tn
Thank for your response. I requested the test because of family history. I did the standard ecg treadmill test without the radiation scan a few years before, and it was okay. Maybe they stopped because the test was for 8 mimutes. I felt I was close to my limit given my breathing was heavier.
The other test has identified an issue, and I am seeing the cardiologist soon.
I prefer to see these reports in a language I can understand.
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Avatar_m_tn
Well discuss everything with your doctor.
Having said that,  you are age 60 with some family history.

You should not be at the end of your rope, overly tired at 10 mets, unless you are in the "normal' standard low fitness of most 60 year olds.
Time to face the next 20 years and decide to improve your fitness/exercise as well as your diet.   Other wise you'll face increasing declines in fitness, only at a much more rapid pace.
To be "average" fitness,  cholesterol, and weight,  is NOT being healthy.

Most 60 year olds are out of shape, have high cholesterol and overweight.
Thus "average" is not that good.   That is why so many people have heart disease.   Has more to do with their family diet than family genes.
You didn't mention if you are on any meds?
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976897_tn?1379171202
The heart rate and Mets were spot on for the time you spent doing the test. Having achieved that treadmill speed within that amount of time with your required heart rate showed through you mets that you have a healthy heart for someone your age.Your cardiovascular system was pushing the right volume of oxygen through your body to supply your working muscles.
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Avatar_m_tn
I agree that since he got to 10 Mets it is probable that his heart,  in that test, showed a healthy response.
However there are many people over age 60,  who can get to 10 Mets and fail to reveal underlying heart problems.
Part of the problem in the way the test is conducted is that they use the formula of 85% times maximum heart rate as the goal to end the test.
However many many people have a maximum heart rate that is far higher than the "calculated" maximum heart rate one gets from the formula of 220 minus your age.   In this case 136.  At 140 bpm was taken to 87.5% of his "calculated" maximum heart rate.  In this case that might be fine,  but for many patients, using that formula, and not taking the heart rate higher gives a false negative test.
I had such a test which indicated everything was fine.
However my true maximum heart rate was much higher and thus cutting off the test at 85% or 90% of my true maximum heart rate did not allow me to reach a point of exertion where the ischemia showed up on the profusion test.
Many instructions for the profusion testing call for allowing the patient to exercise to a level of perceived exertion that is often far higher than the calculated percentage of maximum heart rate.
I would feel angina on every bike ride, yet got a negative outcome from the perfusion test.
A better way to judge exertion is the Borg Scale.
I was age 62 and did 12.8 Mets but was no where near the  point where I get angina.  Then they shut down the test and I was told there was no problem.     Later, after months of angina on every single bike ride, I was given a CT angiogram which clearly showed the blockage in my mid LAD.
Had I been allowed to walk-run on the treadmill to the point nearer to my maximum exertion it is likely the ischemia would have been revealed during the profusion test as it is on every single bike ride I take at greater effort.

Thus I underwent a  significant amount of radiation on a test that was prematurely halted by using only the "calculated' maximum heart rate.
No test is perfect but the way in which this one  is often conducted leaves to many false negatives.
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976897_tn?1379171202
A nuclear scan according to my cardiologist is the best method for detecting when collateral vessels are playing a role. Too many blockages and even the wrong ones are intervened leaving patients full of angina symptoms. The only true way to check the efficiency of arteries is FFR during angiograms.
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Avatar_m_tn
Ed,  thank you for that input.  
I found a brief overview of the subject you raise
http://emedicine.medscape.com/article/1839601-overview

I'll keep that in mind if and when I do a regular angiogram.  
Currently after my diagnosis via CT angiogram,  I have chosen to not do the cath and angiogram.   The reason is that they say they don't want to do it  unless I am willing to accept a stent for any blockage they deem over 70%.
Yet for those who only have symptoms upon significant exertion,  the studies indicate that a stent will not do anything other than prevent angina.
Will not prevent MI or death in most cases of stable angina.

The only time I ever feel angina is upon very vigorous exercise.
Even then it is "walk-through" or "warm-up angina" wherein it lasts from about minute 4 through minutes 12 to 15,  then goes away and I feel zero pain as I get dilation as well as probable collateral circulation.  After 20 minutes I can push as hard as I  want and feel nothing.
However I no longer push to the very limits... so as to not possibly induce ventricular fibrillation and sudden death even when there is no blockage due to a clot.

Right now,  hoping my stenosis is more like 70% and not 90+ percent,  I am doing the full on dietary measures (10% fat) as well as taking atorvastatin 40 mg...  LDL is down to 44.  Seeing if I can get some small percentage reversal over the next 1 to 5 years.   Even a little reversal can give significant improvement in blood flow.   We shall see if the experiment works with me as it has in some small studies (Ornish etc)
Here is a interesting chart on blood flow and the 4x factor

http://hyperphysics.phy-astr.gsu.edu/hbase/ppois4.html

Again, thanks for that info on FFR.   I will make sure they do that if I ever go for the angiogram and potential stent.
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