Stress Echo Interpretation

[rrk6075]

I am 59 yrs old 6ft 5in and 265lbs. I quit smoking 2 1/2  yrs ago. Since I have encountered SOB, Facial colours of blue/red,not being able to lie flat, chest pains on inhalation. A recent stress ecgo showed the following results:
Protocol: Bruce Duration:5:45 Stage:2 Mets:7.0 Peak HR:146 %THR:90% Peak BP:210/100
Baseline 2d imaging demonstrates hypo/akinesis and mid portions of inferior and posterior walls. Low/normal LV function with EF at 55-60%. Immediate post stress imaging demonstrates augmented contractility of all wall segments - inferior and psoterio walls remain relatively hypokinetic.
Abnormal stress echo demonstrating a previous non transmural inferior/posterior MI with some contractile reserve. There is no reversible ischemia.
What does this really mean? The cardiologist said that I have a suspect spot on the back of my heart - not to worry about it and he had no reason for my chest pain.
I also have MR/TR and a dilated aortic root 4.1 and a swollen septum.
All pulmonary function tests are negative.
Should I be alarmed and what should I do especially with the MI?

[kenkeith]

I don't believe you should be alarmed, but you do have some heart issues, and the underlying cause should be treated. Hypokinesis/akinesis indicates there is some heart wall movement impairment, and that usually indicates a lower than normal EF.  the EF is the percentage of blood pumped with each heartbeat and normal is 50 to 70%.  However, the low normal EF may not be an issue, the issue may be a heart filling capacity with an enlarged (swollen septum that is the wall separating both sides of the heart) reduces the capacity of filling chamber and less blood is pumped into circulation with each sroke.

I had hypokinesis about 7 years ago and my EF was below 29% and the underlying cause was coronary vessel blockage.  The underlying cause has been successfully treated and there was a tent implant to immediately supply oxygenated blood to the hypokinetic heart cells and that revitalized the cells...akinetic cells are dead cells and cannot be revitalized.

It seems to me your SOB, would be related to a low cardiac output, however, chest pain with inhalations does not usually indicate a heart issue but more related to the pulmonary system...but it could be both!  You really can't do much with a prior heart attack (MI) but reduce the heart's workload for impaired contractility....but you EF doesn't indicate an impaired contractility!?

Thanks for the question.  If you have any further questions or comments you are welcome to respond.  Take care,

Ken