I'm a 53 year old female, nonsmoker, no cardiac risk factors, excellent lipid profile, quite fit. History of MVP w/ trace MR and RVOT PVCs. Meds: Verapamil SR 180 mg. b.i.d. Going through very stressful period after losing both parents late last year. This winter had several bouts of severe, prolonged chest pain, diffuse and nonradiating, not exercise-related. EKG normal during symptoms. In March I had a Cardiolite treadmill test to rule out ischemia. 12:51, went to 171 bpm with no symptoms, 14.8 mets. No ischemic EKG changes, no arrhythmias, bp response normal. Scan showed a small, mild, reversible anterior wall defect that "does not meet criteria for abnormality by quantitative analysis". Motion corrected scan but not attenuation corrected. Cardiologist reading the scan said the defect could be an attenuation artifact but suggested a stress echo as followup. My cardiologist prefers to wait a year and repeat unless my symptoms come back, saying that clinically he believes I do not have obstructive CAD. His dx is possible vasospasm brought on by grief/stress.
1. In your opinion, is it reasonable to take a wait and see approach given my history?
2. How often does a reversible "defect" prove to be an artifact? From what I've read, if it was attenuation artifact over the anterior wall, it would likely be breast attenuation which usually causes a fixed defect unless the breasts are large. My breasts are small and dense, so I don't understand how they could move enough between scans to cause an apparent reversible defect.
3. Could this "small mild defect" be showing an area of lesser perfusion from a plaque not severe enough to cause actual ischemia directly, but that could make me prone to focal vasospasm?
4. Sensitivity of stress echo vs nuclear stress?
5. Are there any other tests that you would recommend?
BTW I had a 2D echo in Feb 2008 that showed normal valves and chamber sizes except for a mildly dilated RA. EF 60%.