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Heart & Cardiology/Interpretation of Test Results of Myocardial Perfusion

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Question
Dear Dr. Ahmad,
Thank you for taking my question.
I am 61 year old female. I recently did a Exercise Stress test which was negative for ischemia. Based on the advice of my cardiologist, I followed up for Perfusion Imaging Test. The results came as "The heart size is normal. Perfusion imaging shows evidence of a small sized mildly reversible basal inferior defect extending into the lateral wall. Gated wall mtion analysis shows normal wall motion of the left ventricle. Ejection fractio at rest and post stress was greater than 70%. Exercise stress test was negative for ischemia. Perfusion imaging shows a small aread of ischemia involving the inferolateral wall. Ejection fraction is within normal limits."

Please Kindly explain in (1)the extent of ischemia and also if I should follow up with a diagnostic caridac catherization? (2) Can I suggest to my cardiologistthat I be treated with medication without going through the angiogram? Currently I am on Crestor 10 mg. Please explain the pros and cons and your advice.
Thanks in advance,
Evange

Answer
Hi, http://myheart.net/articles/do-i-need-a-stress-test/

A lot depends on the reason you had the stress test. If you are having very concerning symptoms, that have clearly worsened, or having the kind of pain that has resulted in you being hospitalized with concern for unstable angina, or if you have had blood tests or an EKG that is suggestive of a heart attack. Basically a determination of your clinical risk.

In terms of your stress test this is a low risk test. The extent of ischemia is small. The function of the heart is excellent. There is no concerning factor on this stress test that mandates cardiac catheterization and in general the approach to such a stress test would be medical management in the first instance.

I'm going to stop short of giving you exact advice as i haven't seen you and i don't know your case. I can tell you that in general a stress test is done for the purposes of risk stratification and you have a generally low risk stress test which would not warrant catheterization without a trial of medical therapy. The pros of this approach is that it is an evidence based approach. If I were you I would discuss this with your cardiologist and ask for an evidence based explanation of proceeding to catheterization if that is their suggestion.

Hope that was helpful,  

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

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http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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