Aa
Saw Cardiologist today, Confused everyone has different conclusions.
I had my cardiology appt , consulatation today for first time and now I am more confused than ever. Why is it that dr.s can not agree on tests results, etc? After my apparent heart attack early April, Severe squeezing pain to mid chest, pain to jaw, sweating, nausea, rise in blood pressure, feeling faint, feeling of impending doom, lasted about 15 minutes, went home.not to E.R. ( big mistake.) has stress test May 12, 08 Test was given a Persantine injection , since I can not use the tread mill, allso radioactive dye to take pictures of heart. The test showed what is called
REVERSE PERFUSION DEFECT, THE REVERSE PERFUSION DEFECT N THE INFEROSEPTAL REGION AND THIS IS ASSOCIATED WITH HYPOKINESIS OF THE SEPTUM AND INFERIOR SPETUM NEAR CARDIAC APEX.
AND MID CARDIAC SEGMENT. THIS AREA DOES NOT PERFUSE NORMALLY ON STRESS IMAGING,. THE SIGNIFICENCE OF A PARADOXICAL PERFUSION DEFECT VARIES BUT THIS CONDITION MAY OCCUR WITH A RECENT MI. PARTICUARY AFTER REVASCULARIZATION OR THROMBOLYTIC THERAPY.CLINICAL CORRELATION IS ADVISED.
My dr. accepted this as the result of my chest pain episode in april, all the classic symp. of a MI. The dr. forums here, Clevleand Clinic advised that is sounds as if I did indeed have a MI, though mayby a lilttle one, and that I would possibly need an echocardigram with left heart catherization and hopefully the Myocardium was only stunned and still alive.
Now the Cardiologist I saw today didnt neccesary think the same thing, he said there are lots of reasons for Chest pain, but could not specify one, ( I don't have heartburn, indigestion, panic attacks, pleurisy, pneumonia, chest muscle pain or pulled muscle, gallstones or stomache pain, these are the obvious ones. ) I think one thing that threw him off was the fact that my chest pain episodes do not have any particualr pattern, and occur at any time of the day without exercise stressors. I get squeezing tightness in chest, burning pain in my throat, shortness of breath, nausea , faint feeling, rise in blood pressure and heart rate, and fear. Need to sit down. The nurse even said, ' don't call them Angina." I don't know what else to call them as I have never had them before this MI ( feeling...) in April. I can not predict when they will occur. The nurse allso considered my blood pressure of 148/84 ( normal and good ) after taking my blood pressure pill????Anyway, the dr. decided to do the Cardiac Catherization to rule out once and for all what I have or don't have going on with my heart. Are all dr. s this hard to get an opinion , why do dr. s disagree so much?
Has anyone else out there had a reverse Perfusion Defect on their Stress test? I feel so frustrated. I don't know what to think. Is it allways so hard to diagnose problems like this? If I would have gone to the E.R. I would not be having this problem now. There is a part of me that wishes I would have an attack in front of a dr. so I can get a diagnosis. It should not be like that. Any ideas.? fluffypurrcat
REVERSE PERFUSION DEFECT, THE REVERSE PERFUSION DEFECT N THE INFEROSEPTAL REGION AND THIS IS ASSOCIATED WITH HYPOKINESIS OF THE SEPTUM AND INFERIOR SPETUM NEAR CARDIAC APEX.
AND MID CARDIAC SEGMENT. THIS AREA DOES NOT PERFUSE NORMALLY ON STRESS IMAGING,. THE SIGNIFICENCE OF A PARADOXICAL PERFUSION DEFECT VARIES BUT THIS CONDITION MAY OCCUR WITH A RECENT MI. PARTICUARY AFTER REVASCULARIZATION OR THROMBOLYTIC THERAPY.CLINICAL CORRELATION IS ADVISED.
My dr. accepted this as the result of my chest pain episode in april, all the classic symp. of a MI. The dr. forums here, Clevleand Clinic advised that is sounds as if I did indeed have a MI, though mayby a lilttle one, and that I would possibly need an echocardigram with left heart catherization and hopefully the Myocardium was only stunned and still alive.
Now the Cardiologist I saw today didnt neccesary think the same thing, he said there are lots of reasons for Chest pain, but could not specify one, ( I don't have heartburn, indigestion, panic attacks, pleurisy, pneumonia, chest muscle pain or pulled muscle, gallstones or stomache pain, these are the obvious ones. ) I think one thing that threw him off was the fact that my chest pain episodes do not have any particualr pattern, and occur at any time of the day without exercise stressors. I get squeezing tightness in chest, burning pain in my throat, shortness of breath, nausea , faint feeling, rise in blood pressure and heart rate, and fear. Need to sit down. The nurse even said, ' don't call them Angina." I don't know what else to call them as I have never had them before this MI ( feeling...) in April. I can not predict when they will occur. The nurse allso considered my blood pressure of 148/84 ( normal and good ) after taking my blood pressure pill????Anyway, the dr. decided to do the Cardiac Catherization to rule out once and for all what I have or don't have going on with my heart. Are all dr. s this hard to get an opinion , why do dr. s disagree so much?
Has anyone else out there had a reverse Perfusion Defect on their Stress test? I feel so frustrated. I don't know what to think. Is it allways so hard to diagnose problems like this? If I would have gone to the E.R. I would not be having this problem now. There is a part of me that wishes I would have an attack in front of a dr. so I can get a diagnosis. It should not be like that. Any ideas.? fluffypurrcat
I thought I was confused before, now that I have read all these comments, I'm really confused! About two months ago I was put on Atenolol for my high blood pressure. About a week later, my family took me to the ER because I was having really heavy chest pressure and my heart rate was any where from 35-50 bpm. They said it was bradycardia and a reaction to the atenolol, so they stopped that medicine and then put me on Lisinopril. The chest pressure and dull achy pain continued for weeks after that, and my primary doctor said he thinks I have anxiety disorder. I wanted a second opinion...after all, I was having all sorts of things running through my head...is this the on set of a heart attack?... is it the medicine I'm taking?...or do I have some kind of anxiety disorder? Well, one night, I awoke with a really heavy pressure in my left chest. As I sat up, the pressure turned into a tingly pain (felt like hundreds of needles) going from my chest up to my left shoulder and down to my elbow. The whole thing lasted about 2 minutes. I called the doctor and told him I wanted to see a Cardiologist, and if he didn't refer me to one, I would find another primary physician. It took a week, but he finally called me back and said they had me scheduled to see the Cardiologist. This was about 3 weeks ago. Because I have a history of heart disease, stroke, and heart attacks on both sides of my family ( a total of 18 have died of heart related causes), the cardiologist had me under go a nuclear stress test and electrocardiogram. I went last Friday for my follow-up and they said that everything looks normal and my blood work came back good, but my blood pressure is still fairly high..148/98 (I'm now on triamterene), and my heart rate was 53. They want me to go this Thursday and have a Cardiac CTA done. Starting Wednesday morning I have to start taking Lopressor to lower my heart rate for the test. I'm just really worried about this because of my heart rate being so low already. I read on line that anyone who has had a bad reaction to atenolol should not take Lopressor, so I just hope the doctor knows what he's doing. I haven't been having any more sharp pains in my left chest, now I just have a dull, achy pain on the right side about an inch from my breast bone. I have it at rest and while exercising. I just don't know what it could be. I'm tired of all the tests, but I don't want to let this go if it's something serious. Any advice would be greatly appreciated.
HI, as for the panic attacks, I have never had them before. I only felt the Anxiety after the heart symptoms, thinking it must be a MI and wanting to get home as quick as possible. With the following attacks, they have all been with out exercise, without warning, and no panic or fear is a more appropriate word untill after the symptoms.
If you have read my other posts you will know that I have Hypothryroidsim, HIgh Cholesteral, current LDL was 184, ( I am on Zetia and Lipitor) father died of MI, am 20 pounds overweight and sedentary life due to back injury. ( herniated disks, I take Methadone ) The two ekgs I know of showed ST-T wave changes more pronounced, not sure what that means. NO EKGS have been taken during attacks. I will give more infor later. Thanks and I appreicate the help. MOre questions, please ask. fluffypurrcat
If you have read my other posts you will know that I have Hypothryroidsim, HIgh Cholesteral, current LDL was 184, ( I am on Zetia and Lipitor) father died of MI, am 20 pounds overweight and sedentary life due to back injury. ( herniated disks, I take Methadone ) The two ekgs I know of showed ST-T wave changes more pronounced, not sure what that means. NO EKGS have been taken during attacks. I will give more infor later. Thanks and I appreicate the help. MOre questions, please ask. fluffypurrcat
ps after an attack of a supraventricular tachycardia, patients often find they pass large volumes of urine.
that description certainly does sound like acute MI. palpitations are commonly due to supraventricular tacycardias and they onset very suddenly and are preset for a very difinable period of time before subsiding. there is no anxiety BEFORE the attack but there may be during the attack - this is in important distinguishment to make.
the way you describe your inital attack ticks all the boxes for cardiac ischaemia and MI and so i have little doubt that you have had one - have you had an ECG (EKG) since then to look for post-MI stigmate? these would include inversion of T waves of the development of Q waved, or a bundle branch block.
however you say you get attacks recurrently. if these attacks are no tprecipitated by exertion then they could be unstable angina, or, as huw points out, they may be paroxsymal tachycardias.
do you have any other symtoms of atherosclerotic disease? thing would include things like leg claudication (pain in the buttocks of the calved after walking for so long, which when you stop). do you have any renal impairment or retinal (eyes) impairment?
without doing further inviestigations ,namely ECG +- holter monitor echo chest x ray and bloods for cholesterol, triglycerides, thyroid function it is hard come to a diagnosis.
IF your pain was due to reflux disease, i have to admit it would be an unusual presentation but not impossible. this disease is worse on empty stomachs and when laying down, it can cause irritation of the throat and breathlessness and stomach pain. it is relieved by milk and antacids. there should not however be this feeling of impending doom - this is more typical of panic. the question is, are you panicking BEFORE any heart symptoms, ie you have panic disorder, or are you getting heart symptoms then panicking, implying one of the 2 cardiac diagnoses i gave earlier?
billy
junior doc
the way you describe your inital attack ticks all the boxes for cardiac ischaemia and MI and so i have little doubt that you have had one - have you had an ECG (EKG) since then to look for post-MI stigmate? these would include inversion of T waves of the development of Q waved, or a bundle branch block.
however you say you get attacks recurrently. if these attacks are no tprecipitated by exertion then they could be unstable angina, or, as huw points out, they may be paroxsymal tachycardias.
do you have any other symtoms of atherosclerotic disease? thing would include things like leg claudication (pain in the buttocks of the calved after walking for so long, which when you stop). do you have any renal impairment or retinal (eyes) impairment?
without doing further inviestigations ,namely ECG +- holter monitor echo chest x ray and bloods for cholesterol, triglycerides, thyroid function it is hard come to a diagnosis.
IF your pain was due to reflux disease, i have to admit it would be an unusual presentation but not impossible. this disease is worse on empty stomachs and when laying down, it can cause irritation of the throat and breathlessness and stomach pain. it is relieved by milk and antacids. there should not however be this feeling of impending doom - this is more typical of panic. the question is, are you panicking BEFORE any heart symptoms, ie you have panic disorder, or are you getting heart symptoms then panicking, implying one of the 2 cardiac diagnoses i gave earlier?
billy
junior doc
I experienced painless heart palpitations similar to yours described, but without the initial suspect MI. How regularly are you getting these episodes? Have you had an EKG on during one of these episodes as it could make the diagnosis easier. Requesting a halter monitor might let you catch one and change the doctors opinion of how serious these are. My palpitations were idiopathic but likely caused by stress and disappear with counseling, but knowing that my palpitations were not life threatening allowed me to get over the snowballing feeling of doom that seemed to exacerbate it. Fear could be responsible for the nausea, sweating and slight pressure, all triggered by a natural increase in heart rate spiraling out of control with an anxiety attack.
I wish you all the best anyway, and will be keeping an eye on this thread.
Huw
I wish you all the best anyway, and will be keeping an eye on this thread.
Huw
junior Doc, hi, thanks for the information. As for the risk factors I have, here they are, I am 54, had a hysterectomy 2 years ago, so am post menopausal,my dad died of a MI, I have high Cholesteral with a LDL of 184, have high blood pressure, take meds for that and the cholesteral, but is not controlled, am about 20 pds over my Ideal weight, am rather sedentary, ( have a back injury, am on SSI and Social Security. I quit smoking in 1979 thought.
The MI was sudden, intense squeezing pressure, shortness of breath, sweating, nausea, feeling faint, pain to jaw, feeling of impending doom, and of course, denial, Did not go to ER, though should have. The attacks I have had since then are not exactly the same, squeezing pressure is not as intense, but still very noticeable, nausea, sweating, palpatiations, fear, ( no pain to the jaw though...) They come on suddenly, anytime of day with no warning and no exercise. I know what heartburn or indigestion feels like. This is not stomach related, I have had it come on when I have an empty stomache, no food. The MI feelings, I have never had in my whole life, I worked in a hospital for years, so I am very aware of my body.
I would like to talk to you again as you sound very knowledgable and I would appreciate it very much. Thank you in advance. fluffypurrcat
The MI was sudden, intense squeezing pressure, shortness of breath, sweating, nausea, feeling faint, pain to jaw, feeling of impending doom, and of course, denial, Did not go to ER, though should have. The attacks I have had since then are not exactly the same, squeezing pressure is not as intense, but still very noticeable, nausea, sweating, palpatiations, fear, ( no pain to the jaw though...) They come on suddenly, anytime of day with no warning and no exercise. I know what heartburn or indigestion feels like. This is not stomach related, I have had it come on when I have an empty stomache, no food. The MI feelings, I have never had in my whole life, I worked in a hospital for years, so I am very aware of my body.
I would like to talk to you again as you sound very knowledgable and I would appreciate it very much. Thank you in advance. fluffypurrcat
the symptoms you describe do sound to me like an acute myocardial infarction, however the differential in this case from the information i have is esophageal spasm and unstable angina.
the clinical difference between angina and MI are symptoms such as sweating and nausea and voming. the unstable means that this does not come on on exertion as with stable angina, but it unpredictable. was this a one of or ave you had more of these events? if it was jhust a one off, with the symptomology and the history it is highly suggestive of MI. the previous posting is correct in his/her evaluation of the perfusino imaging - it is not means to give a diagnosis but simply add information which must be triangulated with everything else.
the reason i mention esphageal spasm is because it really can mimic MI, and the fact that you said you get a burning sensation in your throat supports this. acid reflux can also cause breathlessness especially when laying flat so you have to take this into account.
as doctors we rely alot on risk factors, so if you have risk factors for cardiac disease then this alters the weightings of the differentials. im sure you know what these are but examples would by high cholesterol, high triglycerides, diabetes, hypertension, smoking, obesity etc.
if you have any specific questions please post and i will try to help
billy
junior doc
the clinical difference between angina and MI are symptoms such as sweating and nausea and voming. the unstable means that this does not come on on exertion as with stable angina, but it unpredictable. was this a one of or ave you had more of these events? if it was jhust a one off, with the symptomology and the history it is highly suggestive of MI. the previous posting is correct in his/her evaluation of the perfusino imaging - it is not means to give a diagnosis but simply add information which must be triangulated with everything else.
the reason i mention esphageal spasm is because it really can mimic MI, and the fact that you said you get a burning sensation in your throat supports this. acid reflux can also cause breathlessness especially when laying flat so you have to take this into account.
as doctors we rely alot on risk factors, so if you have risk factors for cardiac disease then this alters the weightings of the differentials. im sure you know what these are but examples would by high cholesterol, high triglycerides, diabetes, hypertension, smoking, obesity etc.
if you have any specific questions please post and i will try to help
billy
junior doc
I wish I could answer all of your questions! The part about "lit up like a Christmas tree" confuses me too. Maybe he meant that it had patchy bright and dark areas? If you look up SPECT images on the net you can find abnormal ones that look like that. Normal images are smooth and regular.
Not perfusing normally at rest due to stunning does make some sense to me. What they see in the scan is how much of the tracer is taken up into the muscle. It has to be alive and functioning to do that -- scar tissue doesn't absorb the tracer either at rest or under stress and shows up as a fixed defect. So if it shows up as perfusing better under stress then it seems that it must have a blood supply and be capable of functioning at least somewhat.
Myocardial ischemia means the blood supply to the heart muscle isn't adequate for the demands that are being placed on it, so it isn't getting enough oxygen. You can see what the ST segment and T wave are at http://www.cvphysiology.com/Arrhythmias/A009.htm. ST segment changes are the ones that are most diagnostic of ischemia. It sounds as if you had changes in both the ST segment and the T wave. I'm not sure whether changes in inferior and lateral leads would mean ischemia in those parts of the heart -- someone else here (kenkeith?) might know better. I don't know what more prominent T waves would mean, either. I do know that ST changes have to be greater than ~1 mm on the graph to be considered significant and that usually a borderline abnormal result is considered nondiagnostic.
When you say your doctor became upset over not having the original pictures to look at, I hope he didn't get upset at you over it, after all it's not your fault that you have a difficult case!
My borderline positive test was a "mild" reversible defect in the anterior wall. They see a lot of those in women that are artifacts caused by the breast absorbing the radiation signal. But some of them are real and my primary cardiologist didn't want to do any further testing. Even the doctor on the expert forum here said if it was a blockage it "might be causing me pain when I exert myself" but said it was okay to wait and see, which really blew my mind. So I pushed for a second opinion and was lucky to get a referral to a cardiologist who could do a stress echocardiogram on the spot, in his office, which turned out totally negative. But the stress echo is not quite as sensitive for mild ischemia as the nuclear test, and he also said that the impending doom feeling was "a really bad sign". I have no trouble believing that, it felt like death was watching over my shoulder. So I'm relieved but not totally resting easy. I haven't had that feeling in over two months now, but if it ever comes back, I'll scream bloody murder to get into a cath lab if I have to.
Not perfusing normally at rest due to stunning does make some sense to me. What they see in the scan is how much of the tracer is taken up into the muscle. It has to be alive and functioning to do that -- scar tissue doesn't absorb the tracer either at rest or under stress and shows up as a fixed defect. So if it shows up as perfusing better under stress then it seems that it must have a blood supply and be capable of functioning at least somewhat.
Myocardial ischemia means the blood supply to the heart muscle isn't adequate for the demands that are being placed on it, so it isn't getting enough oxygen. You can see what the ST segment and T wave are at http://www.cvphysiology.com/Arrhythmias/A009.htm. ST segment changes are the ones that are most diagnostic of ischemia. It sounds as if you had changes in both the ST segment and the T wave. I'm not sure whether changes in inferior and lateral leads would mean ischemia in those parts of the heart -- someone else here (kenkeith?) might know better. I don't know what more prominent T waves would mean, either. I do know that ST changes have to be greater than ~1 mm on the graph to be considered significant and that usually a borderline abnormal result is considered nondiagnostic.
When you say your doctor became upset over not having the original pictures to look at, I hope he didn't get upset at you over it, after all it's not your fault that you have a difficult case!
My borderline positive test was a "mild" reversible defect in the anterior wall. They see a lot of those in women that are artifacts caused by the breast absorbing the radiation signal. But some of them are real and my primary cardiologist didn't want to do any further testing. Even the doctor on the expert forum here said if it was a blockage it "might be causing me pain when I exert myself" but said it was okay to wait and see, which really blew my mind. So I pushed for a second opinion and was lucky to get a referral to a cardiologist who could do a stress echocardiogram on the spot, in his office, which turned out totally negative. But the stress echo is not quite as sensitive for mild ischemia as the nuclear test, and he also said that the impending doom feeling was "a really bad sign". I have no trouble believing that, it felt like death was watching over my shoulder. So I'm relieved but not totally resting easy. I haven't had that feeling in over two months now, but if it ever comes back, I'll scream bloody murder to get into a cath lab if I have to.
Hi, thanks for bothering to answer and help me try to understand what is going on. One thing that I found out is that my EKGS for the last year have been what they term, Borderline Abnormal. The first one said Sinus Bradycardia, Inferior and larteral ST-T changes.BORDERLINE ABNORMAL CHANGES POSSIBLY DUE TO MYOCARDIAL ISCHEMIA.
What does that mean, the Inferior and lateral St-T changes and Myocardial Ischemia.?
Also the last EKG I had done about a week before the Stress test in the drs office who referred me for the Stress Test and the Cardiology appt says this;
Sinus Rhythm, ST-T changes in the lateral leads. BORDERLINE ABNORMAL CHANGES POSSIBLEY DUE TO MYOCARDIAL ISCHEMIA .
My dr. looked at it and made the comment, T waves more pronounced today . What are the T-Waves and what would more pronounced mean? ( I noticed that the Stress test mentioned Inferior Septum, are they possibly the same area of the heart?)
I have to get the EKG that I had taken the day of the Stress test, it would be interesting to see what it says. I don't remember if I mentioned that one reason the cardiologist was upset was that he did not get to see the Pictures of my heart that were taken during the stress test, and that makes sense.
One other question I have and it seems that you seem to know more than I do so I think you can problaby give me the answer to this. If the heart is lit up LIke a Christmas tree on resting image, ( my dr. s description ) does that mean that there was lots of perfusion going on, what normally would perfuse on Stress or exerciseing instead did the reverse.
So if this area perfuses abnormall at rest, does that mean there may be a blockage there ?And then on Stress or exercise those same areas did not perfuse normally, hence they may be damaged or as another doctor on this forum, ( Cleveland Clinic put it,) there is an area that is Stunned, and hopefully still alive and can be revived. Does that make sense to you?I am axious to have this test on next Monday so I can get some answers.
So what was your borderline Positive Perfusion test, what does that mean? What are they doing now ?I am sorry to hear about your parents, it is normal to have stress with a traumatic event like that, who wouldn't ? Thank you for all your help, it is letting me rest a little easier, though I doubt if I will totally rest till I have this catherization and get an explanation. Take care. fluffypurrcat
What does that mean, the Inferior and lateral St-T changes and Myocardial Ischemia.?
Also the last EKG I had done about a week before the Stress test in the drs office who referred me for the Stress Test and the Cardiology appt says this;
Sinus Rhythm, ST-T changes in the lateral leads. BORDERLINE ABNORMAL CHANGES POSSIBLEY DUE TO MYOCARDIAL ISCHEMIA .
My dr. looked at it and made the comment, T waves more pronounced today . What are the T-Waves and what would more pronounced mean? ( I noticed that the Stress test mentioned Inferior Septum, are they possibly the same area of the heart?)
I have to get the EKG that I had taken the day of the Stress test, it would be interesting to see what it says. I don't remember if I mentioned that one reason the cardiologist was upset was that he did not get to see the Pictures of my heart that were taken during the stress test, and that makes sense.
One other question I have and it seems that you seem to know more than I do so I think you can problaby give me the answer to this. If the heart is lit up LIke a Christmas tree on resting image, ( my dr. s description ) does that mean that there was lots of perfusion going on, what normally would perfuse on Stress or exerciseing instead did the reverse.
So if this area perfuses abnormall at rest, does that mean there may be a blockage there ?And then on Stress or exercise those same areas did not perfuse normally, hence they may be damaged or as another doctor on this forum, ( Cleveland Clinic put it,) there is an area that is Stunned, and hopefully still alive and can be revived. Does that make sense to you?I am axious to have this test on next Monday so I can get some answers.
So what was your borderline Positive Perfusion test, what does that mean? What are they doing now ?I am sorry to hear about your parents, it is normal to have stress with a traumatic event like that, who wouldn't ? Thank you for all your help, it is letting me rest a little easier, though I doubt if I will totally rest till I have this catherization and get an explanation. Take care. fluffypurrcat
Hi, I saw your later post and wanted to comment, but thought it might be more appropriate here since I haven't had the same finding.
I'm so sorry that you're having so much trouble getting a diagnosis, that's pretty much where I was too until yesterday, since my parents passed in December and I started having a lot of the same symptoms, chest pain at rest with feeling of impending doom, tightness in the throat, palpitations, and not knowing where to turn since my cardiologist kept saying it's all from stress, and that I should see a psychiatrist, even without doing any tests except for an EKG. Then in March I had a borderline positive nuclear stress test that I only learned the result of when I asked the doctor for a copy of the report so I could take it to get a second opinion on my symptoms. It's so frustrating! Many doctors make snap judgements and don't really listen to us when we say that we know something is wrong, we know our bodies better than they do.
About the reverse perfusion defect, I'm not an expert but I've done a lot of research and reading on nuclear perfusion imaging tests and I think it's the opposite of a "reversible" perfusion defect. Usually if you have a blockage, the entire heart looks like it is perfusing normally at rest, but if you place greater demands on it like through exercise or chemicals (persantine), then they can see the areas that are blocked and can't meet the increased need for oxygen and those areas show up as perfusion defects. They're called "reversible" because they go back to normal when the heart relaxes. It sounds like in your case, there were areas that showed worse perfusion at rest than under stress, which is the opposite of what they expect so they call it a "reverse defect".
The online literature really does seem divided on whether reverse perfusion patterns mean anything, which is probably why some of your doctors think it's a normal result and others side with the research that says it correlates with a recent MI and "residual tissue viability", meaning muscle that is still alive, but not functioning. Plus some cardiologists are skeptical of nuclear perfusion imaging because there are so many ways that you can get results that look abnormal, but are really artifacts. It sounds as if your EKG is probably normal, or within normal limits, and your EKG never did show anything abnormal on the stress test, only the images came out abnormal. To my (lay) eyes the thing that looks the most ominous is that they found hypokinesis (reduced motion) in the same areas that seemed to not perfuse normally, plus your symptoms sounded classic. So if I were you I would probably assume that I really did have a MI as much as I would want to believe that I didn't, but keep in the back of my mind that the imaging results might be a red herring.
I think the best part of all of this is that you are having the catheterisation soon and that you won't have to wait too long to get answers. It's very frightening, but I know I'd rather know for sure if there was any doubt, that way if there is a blockage they can hopefully stent it. If there isn't a blockage, maybe they can still induce a spasm and cause your symptoms under controlled conditions, another possible answer. I'll be thinking positive thoughts for you. I hope you'll keep us posted on the results.
I'm so sorry that you're having so much trouble getting a diagnosis, that's pretty much where I was too until yesterday, since my parents passed in December and I started having a lot of the same symptoms, chest pain at rest with feeling of impending doom, tightness in the throat, palpitations, and not knowing where to turn since my cardiologist kept saying it's all from stress, and that I should see a psychiatrist, even without doing any tests except for an EKG. Then in March I had a borderline positive nuclear stress test that I only learned the result of when I asked the doctor for a copy of the report so I could take it to get a second opinion on my symptoms. It's so frustrating! Many doctors make snap judgements and don't really listen to us when we say that we know something is wrong, we know our bodies better than they do.
About the reverse perfusion defect, I'm not an expert but I've done a lot of research and reading on nuclear perfusion imaging tests and I think it's the opposite of a "reversible" perfusion defect. Usually if you have a blockage, the entire heart looks like it is perfusing normally at rest, but if you place greater demands on it like through exercise or chemicals (persantine), then they can see the areas that are blocked and can't meet the increased need for oxygen and those areas show up as perfusion defects. They're called "reversible" because they go back to normal when the heart relaxes. It sounds like in your case, there were areas that showed worse perfusion at rest than under stress, which is the opposite of what they expect so they call it a "reverse defect".
The online literature really does seem divided on whether reverse perfusion patterns mean anything, which is probably why some of your doctors think it's a normal result and others side with the research that says it correlates with a recent MI and "residual tissue viability", meaning muscle that is still alive, but not functioning. Plus some cardiologists are skeptical of nuclear perfusion imaging because there are so many ways that you can get results that look abnormal, but are really artifacts. It sounds as if your EKG is probably normal, or within normal limits, and your EKG never did show anything abnormal on the stress test, only the images came out abnormal. To my (lay) eyes the thing that looks the most ominous is that they found hypokinesis (reduced motion) in the same areas that seemed to not perfuse normally, plus your symptoms sounded classic. So if I were you I would probably assume that I really did have a MI as much as I would want to believe that I didn't, but keep in the back of my mind that the imaging results might be a red herring.
I think the best part of all of this is that you are having the catheterisation soon and that you won't have to wait too long to get answers. It's very frightening, but I know I'd rather know for sure if there was any doubt, that way if there is a blockage they can hopefully stent it. If there isn't a blockage, maybe they can still induce a spasm and cause your symptoms under controlled conditions, another possible answer. I'll be thinking positive thoughts for you. I hope you'll keep us posted on the results.
Michelle, hi, I can't imagine what you have been going through with your little one. I have two children of my own, and my little son, is now 33 ( my GOD, they grow up way too fast, my daugher btw is 28. I know my son has Asthma pretty bad when he was about 4, started with constant ear infections, developing into pnemonia and other URIs, and after they took his tonisils, adneoids and did bilateral ear tubes, his allergies all went to his chest, and he developed Asthma. He never had the chest symptoms your little guy seems to have.
I think you are right when you said you would have to take a picture with your cell phone camera to document what is going on with him, I think that is a good idea but it should not have to come to that. I hope that his upcomming appt finally gets him the help he needs and the relief you need. I really feel for both of you. When you get to be my age, ( 50 +) and then have family history of heart disease and other things that put you in the risk category, you can expect something can happen, but children are supoosed to be healthy little beings.
I can not diagnose exactly what I have, because I am not a doctor and do not have the marvelous equipment they have. But I have worked in hospitals off and on since the 1970's and did home health care, besides taking care of children as a teacher for many years, and I do know more than anything what is Normal for me. It is not like I was sick or had chest pain symptoms before and then had this MI, or Apparent MI. I knew when it happened that it was NOt NOrmal, it scared me and it felt terrible. My dad died of a Heart attack,and It has allways scared me the thought of having a heart attack.
It is very frustrating to not get an answer right away and for doctors to not even agree on a diagnosis, but at least I am getting the opportunity to get this cardiac catherization and hopefully it gives some answers, that I do have some blocked arteries or something else that is causing the chest pain I now have sporardically and caused the symptoms of a MI. I dont mind if I did have a heart attack, it is not being able to get a diagnosis that is the real pain. I am sure you know what I mean by that. It is like having a fever of 103-104 and being too sick to go to the dr. and then when you go to the dr. your temp is normal, and the dr. thinks you were never as sick as you say you were. LOL. Oh well, not much you can do about that.
If for some reason this cardiac catherization doesnt show any blockage or heart damage, then I will have to brainstorm to see what else there is. I don't believe in " miracle overnight Healings." My husband said it was my " wake up call" and it is true to some degree, but I still need to find the answers. I hope your son gets his answers soon and no more crushing strawberries or grapes being run over, that is so graphic, everyone can understand that . By the way, what dr. would not understand that? I have never heard of Gas that goes down the arm, ......but I am not the doctor.LOL.
You are right I won't give up and thank you for your thoughts and well wishes. I hope your right that I will get some answers. Keep us informed on your sons appt, what day is it? My catherization is set for June 2nd. fluffypurrcat
I think you are right when you said you would have to take a picture with your cell phone camera to document what is going on with him, I think that is a good idea but it should not have to come to that. I hope that his upcomming appt finally gets him the help he needs and the relief you need. I really feel for both of you. When you get to be my age, ( 50 +) and then have family history of heart disease and other things that put you in the risk category, you can expect something can happen, but children are supoosed to be healthy little beings.
I can not diagnose exactly what I have, because I am not a doctor and do not have the marvelous equipment they have. But I have worked in hospitals off and on since the 1970's and did home health care, besides taking care of children as a teacher for many years, and I do know more than anything what is Normal for me. It is not like I was sick or had chest pain symptoms before and then had this MI, or Apparent MI. I knew when it happened that it was NOt NOrmal, it scared me and it felt terrible. My dad died of a Heart attack,and It has allways scared me the thought of having a heart attack.
It is very frustrating to not get an answer right away and for doctors to not even agree on a diagnosis, but at least I am getting the opportunity to get this cardiac catherization and hopefully it gives some answers, that I do have some blocked arteries or something else that is causing the chest pain I now have sporardically and caused the symptoms of a MI. I dont mind if I did have a heart attack, it is not being able to get a diagnosis that is the real pain. I am sure you know what I mean by that. It is like having a fever of 103-104 and being too sick to go to the dr. and then when you go to the dr. your temp is normal, and the dr. thinks you were never as sick as you say you were. LOL. Oh well, not much you can do about that.
If for some reason this cardiac catherization doesnt show any blockage or heart damage, then I will have to brainstorm to see what else there is. I don't believe in " miracle overnight Healings." My husband said it was my " wake up call" and it is true to some degree, but I still need to find the answers. I hope your son gets his answers soon and no more crushing strawberries or grapes being run over, that is so graphic, everyone can understand that . By the way, what dr. would not understand that? I have never heard of Gas that goes down the arm, ......but I am not the doctor.LOL.
You are right I won't give up and thank you for your thoughts and well wishes. I hope your right that I will get some answers. Keep us informed on your sons appt, what day is it? My catherization is set for June 2nd. fluffypurrcat
welcome to my world. I know exactly what you are going through. at least they aqre willing to find out once and for all. it tool me close to 4 years for Chris. his heart doctor said it was his asthma and asthma said no it was heart. the cardiologist didn't believe anyhting i was saying. I had to show proof by taken pictures with my cell phone of Cree Cree's(realname is Chris) saturation level. they really don't know what the heck is going on with him they do know it is cardiac. he thinks and still does that Cree Cree's chest pain is gas. even though he has been on gas medication prior. and the way Cree Cree describes his pain, it feels like one grape and one strawberry being run over by a truck and grabbing his left chest and then another time grabing his left chest and saying the pain is going down the insdie of his leg and down his arm(both on the left side) COME ON what am I suppose to do video tape his chest pain the one about his tire he was sleeing and had been for several hours.
my advice is to keep pushing until you gt the answers to your questions and make sure you don't leave until you understand what they are telling you. you are the patient you have that right to know what all this means
good luck
michelle
my advice is to keep pushing until you gt the answers to your questions and make sure you don't leave until you understand what they are telling you. you are the patient you have that right to know what all this means
good luck
michelle
Have an Answer?
You are reading content posted in the Heart Disease Community
Is a low-fat diet really that heart healthy after all? James D. Nicolantonio, PharmD, urges us to reconsider decades-long dietary guidelines.
Can depression and anxiety cause heart disease? Get the facts in this Missouri Medicine report.
Fish oil, folic acid, vitamin C. Find out if these supplements are heart-healthy or overhyped.
Learn what happens before, during and after a heart attack occurs.
What are the pros and cons of taking fish oil for heart health? Find out in this article from Missouri Medicine.
How to lower your heart attack risk.
