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Cardiovascular Disease Prevention (Expert Forum)
Want Opinion Please. Am I at risk for further MI ?
Answered by
Lee Kirksey, MD - Peripheral Arterial Disease, PAD, Cardiovascular Disease, stroke, treatment, angioplasty, spider veins, laser ablation, wound treatment, surgery, leg pain, Prevention, Varicose veins
Penn Presbyterian Medical Center of the Univ. of Pennsylvania Healthcare Clinical Assistant Professor at The University of Pennsylvania School of Medicine
Philadelphia - PA
Questions in the Cardiovascular Disease Prevention forum are answered by Dr. Lee Kirksey, associate professor at The University of Pennsylvania School of Medicine.
Want Opinion Please. Am I at risk for further MI ?
by fluffypurrcat, May 17, 2008 04:11PM
Hi DR. , I have posted in other forums but need an opinion from another DR., please! I am a 54 year old female, Hyperlipidema, Father died of Acute MI at age 60. I about 20-25 pds overweight since hurting my back.
In April of this year, I suffered epsiode sudden chest pain, squeezing pressure, hard to breathe, pain to jaw, nausea, sweating, feeling faint , impending doom , episode lasted at least 15 minutes. Just wanted to get home, Took 1 asp and went to bed. Should of gone to ER, but was in denial. Saw my DR. for presurgical foot clearnace a couple of weeks later, reported the chest pain. ( Episode occured while standing in Video Store ) Dr. referred me for a Stress test, put me on Nitroquick, added Zetia to meds. Told to avoid physical exertion .
Results of Stress test on 04-28-08. Dipyridamole Stress Sestamibi Myocardial Perfusion Scan and Cardiac Wall motion Analysis..stress imaging of the heart.
Finding.Myocardial perfusion--there is normal perfusion of the left ventricular myocardium at stress with no segmental stress perfusion score greater than 1.. There is decreased perfusion at rest in the inferoseptal region. This reversed
perfusion defect may indicate an area of recent infarction on resting imaging and stunned myocardium on stress imaging. This reversed finding may occur with a recent infarction.
Impression: There was a REVERSE PERFUSION DEFECT N THE INFEROSEPTAL REGION AND THIS IS ASSOCIATED WITH HYPOKINESIS OF THE SEPTUM AND INFERIOR SEPTUM NEAR THE CARDIAC APEXAND MID CARDIAC SEGMENT. THIS AREA DOES NOT PERFUSE NORMALLY ON STRESS IMAGING. THE SIGNIFICENCE OF A REVERSE OR PARADOXICAL PERFUSION DEFECT VARIES BUT THIS CONDITION
MAY OCCUR WITH A RECENT MI, PARTICULARY AFTER REVASCULARIZATION OR THROMBOLYTIC THERAPY.
CLINICAL CORRELATION IS ADVISED.
I. Thank you again Dr.
fluffypurrcat
In April of this year, I suffered epsiode sudden chest pain, squeezing pressure, hard to breathe, pain to jaw, nausea, sweating, feeling faint , impending doom , episode lasted at least 15 minutes. Just wanted to get home, Took 1 asp and went to bed. Should of gone to ER, but was in denial. Saw my DR. for presurgical foot clearnace a couple of weeks later, reported the chest pain. ( Episode occured while standing in Video Store ) Dr. referred me for a Stress test, put me on Nitroquick, added Zetia to meds. Told to avoid physical exertion .
Results of Stress test on 04-28-08. Dipyridamole Stress Sestamibi Myocardial Perfusion Scan and Cardiac Wall motion Analysis..stress imaging of the heart.
Finding.Myocardial perfusion--there is normal perfusion of the left ventricular myocardium at stress with no segmental stress perfusion score greater than 1.. There is decreased perfusion at rest in the inferoseptal region. This reversed
perfusion defect may indicate an area of recent infarction on resting imaging and stunned myocardium on stress imaging. This reversed finding may occur with a recent infarction.
Impression: There was a REVERSE PERFUSION DEFECT N THE INFEROSEPTAL REGION AND THIS IS ASSOCIATED WITH HYPOKINESIS OF THE SEPTUM AND INFERIOR SEPTUM NEAR THE CARDIAC APEXAND MID CARDIAC SEGMENT. THIS AREA DOES NOT PERFUSE NORMALLY ON STRESS IMAGING. THE SIGNIFICENCE OF A REVERSE OR PARADOXICAL PERFUSION DEFECT VARIES BUT THIS CONDITION
MAY OCCUR WITH A RECENT MI, PARTICULARY AFTER REVASCULARIZATION OR THROMBOLYTIC THERAPY.
CLINICAL CORRELATION IS ADVISED.
I. Thank you again Dr.
fluffypurrcat
Doctor's Answer
by Lee Kirksey, MD, May 17, 2008 07:08PM
, May 17, 2008 07:08PM
To: fluffypurrcat
I think your question is are you at risk for further myocardial injury? To summarize what you have told me. You are post menopausal. You have high cholesterol are 25 pounds over ideal body weight. High Blood Pressure? Do you smoke? You're father died of a heart attack at age 60. You had chest pain which was subsequently shown to be an MI by EKG.
By most assessment criteria, you are at high risk for another MI. Your risk is highest within the first 6 months after the event. I would use this as motivation to optimize your health by diet change, exercise, control of cholesterol and blood pressure. I know you have back problems Consider water sports which are excellent for conditioning.
Importantly, if you have another episode of chest pain, you should go to the ER immediately because every minute counts and means more tissue lost.
Finally, what do you think prevented you from going to the ER with the first episode which sounds quite severe. It sounds quite horrifying and I suspect you knew that something was gravely wrong.
By most assessment criteria, you are at high risk for another MI. Your risk is highest within the first 6 months after the event. I would use this as motivation to optimize your health by diet change, exercise, control of cholesterol and blood pressure. I know you have back problems Consider water sports which are excellent for conditioning.
Importantly, if you have another episode of chest pain, you should go to the ER immediately because every minute counts and means more tissue lost.
Finally, what do you think prevented you from going to the ER with the first episode which sounds quite severe. It sounds quite horrifying and I suspect you knew that something was gravely wrong.
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Does the Stress test in your opinion confirm that I did have a MI ? I know it sure felt like what one would feel like. I am having a hard time with the Angina now if that is what they are, because they occur out of the blue with no warning. Deep burning in throat, pressure on chest, hard to breathe, nausea and my blood pressure and heart rate go up hard beating, skipped beats and I feel " scared." I allso suffer from Migraines and wonder if after taking Nitro should I take Asp for headache, or my Migraine pills, Butalibital tablets. ? What would you suggest? Is there one thing I should watch for when I get these chest pains while waiting for my cardiologist appt.? thank you so much for your opinion.
As for not going to the ER. I know I should have and I was sure my husband would have taken me, but I am sure he was in denial too, and he still doesnt realize just how serious it was. Thanks. fluffypurrcat