REVERSIBLE PERFUSION DEFECT IN MYOCARDIUM

[Paul1953]

I had a heart attack 3 years ago and underwent PTCA stenting in right coronary artery. About a year later, I started having PVCs which went up to about 9000 every 24 Hours, though LVEF was 65%. A Myocardial Perfusion Imaging Stress Test with TC 99m, did not show exercise induced ischemia, except for a fixed perfusion defect caused by the earlier heart attack. Probably, after long therapy with Sotalol, my PVCs now stand at 55 every 24 Hours.

Recently I started having pain in my cardiac region and/or dyspnea, specially during stress or physical exertion, which would go after taking nitrate and/or rest. so, now I again underwent another Myocardial Perfusion Imaging Stress Test and it showed, " a small perfusion defect over the apical segment of left ventricular myocardiam." The radiologist told me that the reversibility in perfusion was 8%.

I am presently on Sotalol, Losartan, Rosuvastatin+Ezetimibe, Nitrate, Clopidogrel+Aspirin and Omega 3. I am Eurasian (in India), overweight=105 Kgs & 171 cms tall, leading medium sedate life. My lipids and BP are OK and am non-diabetic.What are the meanings of the nuclear stress tests and what are the things a cardiologist would advice me to do ??  Shall be grateful for detailed advice. Thanks.    

[Paul1953]

Thanks jrbon for your input. Much appreciated.By the way I did not mention that I am 57 years of age,

I shall be grateful if any cardiologist would comment on my situation.

[jrbon]

In my view (just a patient like you) the 8% defect it is of little significance, can just be the consequence of your HA.

The fact that you have stable angina (chest pain and dyspnea on exertion) it is more annoying. Your cardiologist probably would ask for an angiogram to check if there are any occlusion.

My advise, as I am sure that you already knows, is that you should loose weight. I know it is not easy .... here are 2 facts just to try to motivate you:

1) Every kg of meat in your body carry about 1 km (yes 1000m) of vessels . Imaging the extra effort that you are placing on your hart to move the blood 1000m more for each extra kg.

2) Go to your butchery and ask to show you, in a single piece, 30kg of meat (I guess it is about your extra). Yes, my wife did that to me when I was 20kg extra, and I was chocked.

Jesus.