Nuclear Stress Test Results

[michael3763]

42 year old male. Due to continuing PVC's, discomfort and a small 9 beat NSVT, I had a Nuclear Stress done in June 2009. Failing that, I proceeded with an angiogram and needed 2 stents placed. 1 in LAD, 1 in left circumflux and an angioplasty in an LAD branch. A smaller branch of the RCA was left at 70-80% blocked...to be medically managed as it is difficult to reach and possibly not worthwhile. Since then, I have been to the ER 2 times with some chest discomfort and pain. In short, most of my symptoms did not subside. I had 2 Nuclear Stress Tests done with each ER visit...one as recently as 2 weeks ago. Both tests revealed the same results and that the stents are doing well, My Dr.(through the nurse) reassured me that no new action is required at this time. Specifically, could you please comment on the left ventricle perfusion defect and reversibility, what soft tissue attenuation is, and perfusion defect in the RCA. Below are the results.

Findings: Myocardial images acquired following exercise demonstrate a small sized perfusion defect of mild severity in the inferior region of the left ventricle. The rest images reveal complete reversibility in this region. Stress images also reveal a mild decrease of tracer uptake in the anterior area of the apex. The rest images are unchanged in this region. Cavity dilatation is not present. Systolic myocardial thickening and wall motion at rest are normal on gated imaging. The calculated left ventricular ejection fraction is 65%

Impression: Myocardial perfusion imaging is abnormal. The decreased tracer uptake in the anterior area of the apex is likely due to soft tissue attenuation. Nevertheless, there is scintigraphic evidence of a small area of inferior myocardial ischemia, but no clinical or electrocardiographic evidence of ischemia. There is no clear scintigraphic or electrocardiographic evidence of prior myocardial infarction. The perfusion defect is in the distribution of the right coronary artery. There is no scintigraphic evidence of left ventricular dysfunction. Compared to the prior perfusion study of 09/29/09, the overall findings are similar.  

[erijon]

I have to agree with kenkeith, this looks like a very good report overall. When you mention that your pains did not subside, what was the time period? Have they subsided at all since your stents were placed? Are your pains more prevalent with exertion or at rest as well?

Let us know,

Jon

[kenkeith]

There is some mild ischemia (lack of blood flow) due to some vessel blockage or narrowed vessels....usually insignificant.

The systolic thickening ratio is a calculation that involves the metrics of the pumping chamber size just before pumping (filling capacity) and again after pumping (depleted size) provides pumping efficiency by structual capacity and provides analysis when and if there is a thickened chamber wall....the other method to analysis the heart's pumping efficiency is to measure the maximum volume less minium volume divided by maximum volume and your report indicates it is 65% (normal is 55 to 75%), but because there is some systolic thickening the true cardiac output is less than 65% per heartbeat but relatively insignificant.  

Your heart is pumping a normal output and the ischemia is not of any significance.  However, your doctor should give you an explanation for the thickened wall.  Sometimes that is an indication of well trained athlete or it could be pathological.  Regardless, it is not serious at the present time.