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Equivocal test result, what next?
by fizzixgal, Apr 19, 2008 06:23PM
I'm a 53 year old female, nonsmoker, fair bp (110/70 to sometimes 130/80), total cholesterol 134, HDL 76, LDL 48, exercise frequently (regularly during summer months), quite fit. Take Verapamil SR 180 b.i.d. for RVOT PVCs (dx'd 4 years ago). Since losing both parents late last year I've gone through a very difficult time both emotionally and physically. This winter I had several bouts of severe, prolonged chest pain, diffuse and nonradiating, not brought on by exercise. I presented to my cardiologist twice during symptoms, EKG normal both times, troponins normal 24 h after symptoms began. Last month I had a Cardiolite treadmill test to rule out ischemia. I exercised for 12:51, went to 171 bpm with no symptoms, 14.8 mets. No ischemic EKG changes were seen, no arrhythmias, bp response normal. "Questionable" LVH from the resting EKG. The scan showed a small, mild, reversible anterior wall defect that "does not meet criteria for abnormality by quantitative analysis". The scan was motion corrected but not attenuation corrected. The cardiologist reading the scan said that the defect could be an attenuation artifact but suggested a stress echo as followup. My cardiologist prefers to wait a year and repeat the scan unless my symptoms come back, saying that he sees many equivocal results like mine and his clinical sense tells him I do not have obstructive coronary disease. He does say that I might have had 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 have a hard time understanding how they could cause an apparent reversible defect.
3. If another noninvasive test is to be done, would a stress echo make more sense than a repeat stress w/ nuclear scan? How do the two tests compare in sensitivity?
4. Are there any other tests that you would recommend?
BTW I previously had a 2D echo that showed normal valves and chamber sizes except for a mildly dilated RA, EF 60%.
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 have a hard time understanding how they could cause an apparent reversible defect.
3. If another noninvasive test is to be done, would a stress echo make more sense than a repeat stress w/ nuclear scan? How do the two tests compare in sensitivity?
4. Are there any other tests that you would recommend?
BTW I previously had a 2D echo that showed normal valves and chamber sizes except for a mildly dilated RA, EF 60%.
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