AboutDavid Richardson Expertise Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.
Experience Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.
Organizations Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..
Publications Circulation, American Heart Journal, Hypertension.
Education/Credentials M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.
Awards and Honors Gold Heartt Award from American Heart Association in 1995.
Question QUESTION: I am a 53 yr old woman who in the last few yrs was put on hbp, chols, thyroid meds. I had a echo stress test done with persantine and cardiolite on May 05, 2009. Finding came back showing no focal wall motion abnormality. Ejection is 60%. The remainder of the left ventricular myocardium appears normal. The perfusion images demonstrate relative decreased activies in the anterior wall. This appears more normal on the resting study. Findings suggest reversibility and stress induced ischemia cannot be excluded.
Can you tell me what this means and how will this affect my heart. I'm I threating a stroke or heart attack? I am now waiting for the referal to see an cardio docter, but is is taken so long should I take matters in my own hand and find my own specialist. I do not know if time is on my side. concern and worried...... Once I see a cardio specialist what should I expect to possiblely happen after reviewing my findings.
ANSWER: Dear Louise,
It means the front wall of your heart doesn't contract as well as the rest of the heart when Persantine makes the heart beat harder than normal, and suggests that the anterior coronary artery has a narrow place that prevents the increase in blood flow to the front of your heart that should occur with Persantine. And it means that you're at some risk of heart attack if the narrow place becomes totally blocked. You are threatened by heart attack but not stroke. If you have chest pain with exercise or anger or anxiety, you should find your own specialist promptly. If no chest pain or pressure when stressed, then management with medicines is as effective in preventing heart attack or cardiac death as is intervention by blowing up a balloon (at the tip of a flexible catheter introduced into an artery where your leg joins your body and floated in the blood stream up to the heart) to stretch open the narrow place. The medicines include a baby aspirin, a statin, a beta blocker, and an ACE inhibitor like lisinopril or one of its cousins.
Please write back if this note doesn't answer all your questions.
David Richardson
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QUESTION: I have been feeling pain and light pressure at time's of stress or when I am feeling overwhelm, some tightness and going down my left arm pain and my neck gives me pain going into the shoulder. At the time everyone( primary & orthero ) was telling me the chest pain I was feeling came from the neck injury I gotten from an car accident back in 1991 and I had neck surgery in 2007 for the c3 & c4 replacing a bone and a metal plate was put in to hold the bone. My constance complain caused them to do the stress test. I do have a lot going on in my life at this point, I take care of my mother who is 83( I you responded to my question about the swollen eyelids)my mate for 26 yrs is having health issue, I have a sister that is on dialysis and one sister who is living with me has health issue's as well. I have the three that is living with(not the one on dialysis) and they are all counting on me to keep the house going. So I got to get this right. I need to live long enough to take of my mother at least. My father past away in 2001 and she depends on me greatly. I have not told anyone of my condition, because I was waiting to see what the cardio specialist says. The meds I am on are enanpril 20mg 2x day (hbp), simivastation 20 mg 1 x a day (chols), levothyroidixine 75mg (thyroid)and nipiprine 30 mg 1x a day(hbp) and xanax 1mg as needed, hydrocordone as needed 10/325mg. So based on what you said in last respond I'll more then like be going with catheter procedure. Can a person have an heart attack while they insert this device?
Answer Louise, you get to choose. If the pain and light pressure interfere with your life, see a cardiologist, who will probably suggest cardiac catheterization to see exactly where the narrow place is and to open it with a balloon and put in a stent. Your medicines are correct except I suggest 40 mg of simvastatin daily, and addition of a beta blocker at once. Metoprolol and atenonol are examples. 100 mg of atenolol once a day or 50 mg of metoprolol twice a day are the doses. You should take a beta blocker for a few weeks to see if it completely relieves your pain before undergoing catheterization. A heart attack is possible (1-5 %) when the device is inserted and for about 40 days thereafter.
Please let me know what you decide and how it works out.
