stress images demonstrate decreased perfusion at the inferior and posterior wall

[maoshi]

I am 51, male, healthy except high cholesterol, 240-260. I tried Lipitor for a year then stoped half year ago due to bad liver tests. I felt uncomfortable chest pain when sit at rest, but no problem at exercise, heart beat even reach 160 as in my test. What is the possible deseases I have with the following test I have done? I have never had a heart attack before. My chest pain can last half day or a whole day, but not bed time and when I am in relative extensive exercise.

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At rest the patient was injected with 16.77 mCi of Te99m Sestamibi followed by rest SPECT cardiac images. The patient was then injected with 35.2 mCi of Te99m Sestamibi at peak treadmill exercise followed by stress SPECT cardiac images. Cardiac wall motion and ejection fraction were performed.



The stress images demonstrate decreased perfusion at the inferior and posterior walls of the left ventricle that normalizes on the rest images. Cardiac wall motion demonstrates diffuse hypokinesis throughout the left ventricle and left ventricular ejection fraction is 38% (normal range greater than 50%).



Exercise Parameters:

PRP     216

METS   10.8

DURATION     10.15 minutes

MAXIMUM BLOOD PRESSURE   134

MAXIMUM HEART RATE   161



IMPRESSION:

Abnormal stress myocardial perfusion study with wall motion and ejection fraction demonstrating findings indicative of an ischemic cardiomyopathy with reversible ischemia of the inferior wall and abnormal wall motion and ejection fraction as described above.

[maoshi]

Thought that it will benefit somebody who find this thread, I shall finish my story here.
My echo test reported 100% normal with EF ~60%. Last week, I went to a better hospital and repeated the first test. I have just received the report, none of problems in the first report exist! My EF > 60%.
I wonder either the first hospital messed up the test or the report. Although in either case I paid double and suffered double, I hope it was the test they messed up. If they misplaced results, somebody could be in danger.

[tickertock]

what i meant to say i had another ago 2 weeks but iguess you figured that out already.Thanks again.

[tickertock]

Hello and thanks for all your imput. I had been diagnosed with borderline LVH nearly 5 years ago, the measurement was 12mm, a liitle above or = to the upper limits of normal was of interventricular septum at 12 mm, all other values was in the normal range. about 2 weeks I had another echo repeated the interventricular septim was 14mm , all other measurements were within the normal limits,  iknow the echocardiogram is fairly accurate in diagnosing LVH, EF and checking the valves for leaks.

This time the cardio didn't seemed as alarmed as when it was borderline, in fact I got impression my heart from him my heart function was even better than  5 years ago , even though my Ef was down from 64 to 55 , though this time i was much more relaxed.

I realise that you can't comment too much but in your experience can LVH be overcalled sometimes on an echo just as is the case with MVP, like you said no test is 100%.

He says I have nothing like HCM and that my mild LVH is proabably due to mild hypertension, also about 25-30 lbs overweight , 40 year old male, any imput would be much aprreciated. Thanks. I realise that your are not trying diagnose anyone here on the forum and just offering some insights from your experiences though others might get the wrong impression.

[EchoTech]

I would  push for a catherization vs treating medically, especially if the defects are reversable.  I do echocardiograms for a living, and I myself would push for instead of having an echo.  They may be using the echo to check for any valve leaks and reconfirm the ejection fraction.  No test is 100% right all the time, unfortunately.

[LacyMary]

Hi there.

I am wondering what causes seen on an echo words like:  Dynamic LVOT obstruction due to SAM (Systolic Anterior Motion) 30mmhg gradient on last month's Echo and 2 weeks later the same wording but 18mmhg gradient. I am due for another one next week.  EF fraction is around 58%.  Can meds cause these findings?  I read somewhere they can but so many things seen on the internet are incorrect.

Thanks

[maoshi]

Thanks for the posts.
I am going to have  2-D ultrasonic exam next Tuesday.
Currently I am not any medicine to control my cholesterol. Since my liver function does not tolerate Lipitor, I am afraid that other statin based drugs would have the same effect.
Am I wrong with this impression? Do you have any suggestion for alternative medicines? Such as Policosanol.

[maoshi]

More info: My symptom happens only recently in about 3 months. I have been tested high cholesterol since 1997. Will stopping Lipitor be the root of the problem?

[Cleveland Clinic]

maoshi,

Stress test are a noninvasive way of looking for coronary blockages. You symptoms sound very atypical for cardiac pain, called angina. However, there are some concerning findings on your stress test including the decreased blood flow/perfusion in one wall of the heart and a decreased pumping function of the heart.

Most likely the next step would be to rule out blockages in your arteries as a cause of both findings on the stress test with a cardiac catheterization.

good luck