question about nuclear stress test interpretation?

Hello,
      I am a 31 year old female. I have a history of arrythmias pacs, pvcs, thousands per day which lasted for a couple of years and one bout with atrial fib which lasted for 15 hours and converted on my own with I.V drugs. Was put on diltiazem 120 and atenolol 50 mg. and the arrythmias have been stable now for 1 year This is my question: The cardiologist decided to do a nuclear stress test to see how things were going and the results are as follows spect myocardial perfusion scan reveals slightly diminished tracer uptake in the anterir apex and spectum without improvement on the delayed images. The gated ejection fraction is 64%  1. Equivocal or midly abnormal spect myocardial perfusion scan with a persistent anteroapical wall decrease tracer without signs of reversibility. This may represent previou scar, but patient has normal left ventricle wall systolic function and contractibility. 64% ej. I was concerned and wondered if I needed a cardiac cath? Could this scar be from previos heart attack? I am very concerned I need your opinion.Thanks B.W

[CCF-M.D.-KE]

Dear Wailan,

You have described a thallium scan (exercise or persantine?) suggestive of an anteroapical scar with a normal ejection fraction .  The scar could represent an old heart attack. This abnormality could also represent a primary disease of the heart muscle or attenuation from nearby anatomical structures. If this result truly represents a scar in the heart muscle,  you are at increased risk from a cardiac stand point.  However, these tests are not perfect and sometimes  show an abnormal result when there is no disease and a normal result when there is disease. Given your age and what sounds like few cardiac risk factors this may likely represent a false positive result.  A false positive result is an abnormal test result in the absence of disease.

I discussed your case with nuclear medicine specialists here and we agreed that your result  could be a false positive. Although, a left heart catheterization is not an unreasonable idea, you may consider having a PET scan done first. A PET scan is non-invasive nuclear test which is more reliable than the thallium scan. Hope this helps.


Thanks for your question,


CCF-MD-KE