stress test results

My husband just received his results from recent stress test.  (He is 36 y/o.  Father had first double bypass at 37 and died at 56, so there is a family history of heart issues.)  Stress spect cardiolite images decreased cardiolite uptake in anterior and inferior walls.  Spect cardiolite scan was positive for moderate amount of ischemia of anterior and inferior walls.  Comments:  1. Anterior defect/possible soft tissue/breast attenuation artifact, 2.  Inferior defect/possible soft tissue/breast attenuation artifact, 3.  Consider PET viability/ischemia.  Also stated:  Appropriate augmentation of contractile function in all visualized segments on stress first pass acquisition.  His HR reached 169, BP reached 142/92 in the 7.5 min test.  Thoughts?  Cardiologist ordered angiogram for this Friday.

[jrbon]

What symptoms does he has? Is he already under medication?

It seems to me that he cannot have a too big blockade otherwise he will not have normal contractile function under stress. Also he reached a 92% of his maximum HR ... so the angiography I think is only justified based on the symptoms.

Anyway, good luck tomorrow, and keep us updated.

Jesus

[ed34]

The echo is too vague and the technician is concerned some of the results could be due to tissue density in the chest interfering with the imaging. The only way to be sure it isn't ischemia is to have an angiogram or ct scan.

[oldie]

have you accepted that a CT scan is as effective as the 'gold standard' catheter angiogram?
Which kind of CT please? The 64-slice? That's the latest I have heard of.

[ed34]

Well I am still not certain. When I visited my cardiologist about 4 months ago, I asked if I could have a ct scan done of my coronary arteries to make sure the new stents are holding up. It was discovered through a stress echo that they are, but her reply regarding ct scan was "No, the trouble with ct scans is they don't show up smaller arteries clearly enough". She didn't mention what scanner they have at my hospital, but apparently better resolution doesn't mean better results/images. I read an article where 128 slice and I believe there's one over 300 now in use, but some experts are complaining because the images are much more difficult to make out. These are especially those dealing with the brain. So I guess I'm still on the fence and I have no idea if my hospital even has a 64 slice or higher.
Another thing to consider is the amount of extra information you can gather from an angiogram, because you actually inside the body. Such as using an FFR sensor on the catheter to see the flow/pressure drops across blockages. You couldn't obtain this from a ct scan. Oh, perhaps one more thing to consider. A standard angiogram takes what? around 15-20 minutes? This is quite a long time to be observing arteries in comparison to a snapshot taking a few seconds. Wouldn't there be more of a chance of catching vasospasm in action with an angiogram?