Your Heart Health: Insights from Myocardial Perfusion Reports

Q: Your Heart Health: Insights from Myocardial Perfusion Reports

Hello, chest pain is generally not related to the heart rate. <br>The symptoms should be considered atypical. <br>The attending physician may use medication for management. <br>If you still feel uncomfortable or are concerned, you may opt for a self-paid CT scan. <br>Changhua Hos

I would like to ask the doctor to review this report?

1.
I would like to ask the physician to review these two reports regarding the degree of myocardial ischemia and myocardial perfusion: The Tl-201 myocardial perfusion SPECT scintigraphy was performed 5 minutes after intravenous injection of 2.5 mCi Tl-201 with dipyridamole intervention (0.56 mg/kg over 4 minutes for stress) and at 4 hours after redistribution (rest).
Results: The Thallium-201 Myocardial Perfusion SPECT Study with Dipyridamole Stress Intervention shows reverse redistribution in the mid to basal inferolateral wall, mid to basal inferior wall, and basal septum.
There is mixed myocardial scarring with ischemia in the basal inferoseptal wall and basal septum.
Reversible myocardial ischemia is noted in the apico-inferior wall and basal anteroseptal wall.
Severity of lesions is classified as mild to moderate, with the most prominent lesions located in the basal inferoseptal wall, basal septum, and basal anteroseptal wall.
The extent of stress and rest defects is 2% and 6%, respectively.
The transient ischemic dilatation (TID) ratio is 1.03 (normal reference: < 1.22).
Remarks: 1.
All parameters shown in this imaging report were derived from the "Emory Cardiac Toolbox" (ECTb), a software approved by the FDA (USA) for cardiac image decision support.
However, these parameters should be further correlated with clinical features.
2.
Travain et al., Semin Nucl Med.
1999;29(4):298: Sensitivities: 83%-97%; Specificities: 38%-94%.
The overall sensitivity of myocardial perfusion imaging (MPI) is about 80% to 90% (Essentials of NM and Molecular Imaging 2019;5:146).
3.
Reverse redistribution has been shown to be associated with (1) post-myocardial infarction events and/or (2) chronic coronary disease (vascular abnormalities, inappropriate wall motion, or decreased resting flow); however, (3) normal variants should also be considered.
4.
Low sensitivities may be observed in clinically high-risk cases, and low specificities may be related to referral bias and technical artifacts.
Please evaluate clinically, and we would like to follow up closely.

Exercise Electrocardiogram: Purpose: 1.
(V) Diagnosis; 2.
( ) PTCA; 3.
( ) PTMV; 4.
( ) Drugs; 5.
( ) CABG; 6.
( ) Rehabilitation; 7.
( ) Arrhythmia; 8.
( ) Screening; 9.
( ) Others.
Pre-exercise ECG: Blood Pressure: 126/79.
Medications: ( ) Yes (V) No.
Patient Fasting: ( ) Yes (V) No.
Stage: Speed/Grade (MPH/Grade): (1.7/10) (2.5/12) (3.4/14) (4.2/16) (5/18).
Minutes: 2’ 5’ 8’ R2’ R5’.
Blood Pressure: 140/71 146/70 149/67 153/71 140/73.
Minutes: Blood Pressure: / / / / /.
Exercise Terminated Because of: A.
( ) Maximal Effort F.
(V) Dyspnea K.
( ) Chest Tightness B.
(V) 90% Maximal Heart Rate Obtained G.
( ) Arrhythmia L.
( ) Can't catch up speed C.
( ) ST Segment Shift H.
(V) Leg Pain M.
( ) Exercise intolerance D.
( ) Chest Pain I.
( ) Hypotension N.
( ) Vasovagal Response E.
( ) Fatigue J.
( ) Dizziness O.
Total Time: 10:37.
Maximal Heart Rate (MHR) x Mean Systolic Blood Pressure (MSBP): 166 x 149 = 24734.
Maximal Achieved Rate: 166.
Maximal Predicted Rate: 183.
90% Predicted Rate: 163.

INTERPRETATION OF EXERCISE ECG: 1.
( ) Normal ECG at maximal effort; 2.
( ) Normal ECG at submaximal (90%) predicted heart rate; 3.
( ) Normal ECG at 'inadequate' heart rate of ( ); 4.
( ) Abnormal ST junction and segment elevation ( ); 5.
(V) Abnormal ST segment depression: A.
Downsloping ( ) mm ( ); B.
Flat (1) mm (in leads III, aVF, and V4-6); C.
Upsloping ( ) mm ( ) (from J point to at least 0.08 seconds); 6.
( ) Other (Specify): Comment: 1.
(V) Positive; 2.
( ) Negative; 3.
( ) Inconclusive (specify); 4.
( ) Complication (specify); 5.
( ) Other: Prepared by: Wang Wei-Hua.
Reporting Physician: Fu Hao-Neng (Specialist License No.
S1957).

2.
Initially, I sought medical attention due to chest pain and elevated blood markers during a health check.
The doctor ordered a myocardial perfusion study and exercise electrocardiogram.
Currently, the hospital physician has prescribed one tablet of Atorvastatin daily.
After two months of treatment, my blood values have returned to normal, and the sensation of chest tightness and pain has diminished.
However, I have recently experienced a recurrence of chest tightness and pain.
Upon follow-up, the doctor listened to my heartbeat and performed an electrocardiogram, suggesting that I might just have myofascial pain.
He prescribed antacids and muscle relaxants, but after two days of taking them, I feel no improvement.
I would like to ask the doctor, based on my reports and current condition, whether I should consider paying out of pocket for more advanced tests (such as a CT scan or cardiac catheterization).
Additionally, my heart rate is relatively low (around 50 beats per minute); could this be related to the cause of my chest pain?

Cheng Zack, 30~39 year old female. Ask Date: 2022/01/14

Dr. He Dongjin reply Cardiology

Hello, chest pain is generally not related to the heart rate.
The symptoms should be considered atypical.
The attending physician may use medication for management.
If you still feel uncomfortable or are concerned, you may opt for a self-paid CT scan.
Changhua Hospital cares about your well-being.

Reply Date: 2022/01/14

More Info

Understanding your heart health is crucial, especially when interpreting myocardial perfusion reports and exercise stress tests. Based on the reports you provided, there are several key insights regarding your heart condition and the implications for your health.

Myocardial Perfusion Report Insights
The myocardial perfusion scan you underwent indicated areas of reversible ischemia, particularly in the apico-inferior and basal antero-septal walls. This suggests that during stress, these regions of your heart muscle are not receiving adequate blood flow, which can be indicative of coronary artery disease (CAD). The report also noted mixed viable and non-viable myocardial tissues, particularly in the basal infero-septal wall and basal septum, which raises concerns about potential scarring or damage to the heart muscle.

The severity of the lesions was classified as mild to moderate, with the most prominent lesions located in the basal infero-septal wall. The transient ischemic dilatation (TID) ratio of 1.03 is within normal limits, which is a positive sign, as a TID ratio greater than 1.22 could indicate more severe ischemic conditions.

Exercise Stress Test Insights
The exercise stress test results showed that you achieved a maximum heart rate of 166 beats per minute, which is approximately 90% of your predicted maximum heart rate. However, the test was terminated due to dyspnea and leg pain, which are important symptoms to consider. The presence of ST segment depression during the test is also significant, as it can indicate myocardial ischemia during physical exertion.

Clinical Implications
Given the findings from both the myocardial perfusion scan and the exercise stress test, there are several considerations:
1. Risk of Coronary Artery Disease: The combination of reversible ischemia and the symptoms you described (chest pain and discomfort) suggests that you may be at risk for CAD. The fact that you have experienced chest pain and have a history of elevated blood markers further emphasizes the need for careful monitoring.

2. Follow-Up Testing: Given your symptoms and the findings from the tests, it may be prudent to discuss further diagnostic options with your cardiologist. This could include advanced imaging techniques such as coronary CT angiography or even invasive coronary angiography, especially if your symptoms persist or worsen.

3. Heart Rate Considerations: Your resting heart rate appears to be on the lower side (around 50 beats per minute), which could be a sign of bradycardia. While a lower heart rate can be normal for some individuals, especially athletes, it can also be associated with certain heart conditions. It’s essential to discuss this with your healthcare provider, as it may relate to your symptoms of chest pain.

4. Lifestyle Modifications: Alongside medical management, lifestyle changes can significantly impact your heart health. This includes maintaining a healthy diet, engaging in regular physical activity (as tolerated), managing stress, and avoiding smoking. Since you mentioned a history of smoking, cessation is critical for improving cardiovascular health.

5. Medication Management: You mentioned being prescribed a statin (普妥) which has helped lower your blood markers. It’s essential to continue monitoring your lipid levels and adjust medications as necessary under your doctor’s guidance.

Conclusion
In summary, your myocardial perfusion and exercise stress test results indicate some degree of myocardial ischemia, which warrants further evaluation and possibly more advanced testing. It’s crucial to maintain open communication with your cardiologist about your symptoms and any changes in your health. Regular follow-ups and adherence to prescribed treatments will be vital in managing your heart health effectively. If you continue to experience chest pain or other concerning symptoms, do not hesitate to seek immediate medical attention.

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