Is My Heart Condition Safe for a Myocardial Perfusion Scan?

Myocardial perfusion imaging

Hello, Doctor: I am a patient with arrhythmia.
I underwent catheter ablation in April of last year.
After the procedure, I experienced frequent episodes of arrhythmia that month, including one instance of atrial fibrillation, which required me to visit the emergency room 3-4 times for intravenous treatment.
Afterward, during my follow-up appointment, the doctor prescribed me 100 mg of Rivaroxaban to take twice daily, which I gradually reduced until I stopped taking it.
Currently, I am only taking 5 mg of Concor once a day.

On January 27 of this year, I began experiencing missed beats, initially occurring every two days and lasting half a day each time.
This progressed to daily occurrences lasting the entire day, prompting another visit to the emergency room.
Blood tests showed no issues, but the ECG indicated irregular heartbeats.
The doctor reassured me that it was not a concern.

Yesterday, I suddenly experienced palpitations with a heart rate of 129, accompanied by missed beats and extra beats.
I took Concor at home before heading to the emergency room, where I felt short of breath and had slight chest tightness.
I informed the doctor that after receiving the third dose of the Moderna vaccine on January 18, I experienced swelling in my left arm and under my left clavicle.
I asked if this could affect my heart rhythm, and the doctor said it was possible.

I have a scheduled myocardial perfusion scan on February 18, and I am worried that I might experience another episode during the procedure.
Could you please advise if my current condition is suitable for undergoing this examination on February 18?

Mei, 60~69 year old female. Ask Date: 2022/02/11

Dr. He Dongjin reply Cardiology

Hello, it has been a month since you received the third dose of the Moderna vaccine, and the relative reactions have been mild.
This should not affect your examination on February 18.
You may take one tablet of Kang Keng before the check-up.
Changhua Hospital cares about you.

Reply Date: 2022/02/11

More Info

When considering whether your heart condition is safe for a myocardial perfusion scan, it's essential to evaluate several factors related to your current health status, particularly your history of arrhythmias and recent symptoms. A myocardial perfusion scan is a non-invasive imaging technique used to assess blood flow to the heart muscle, often performed under stress conditions to evaluate for coronary artery disease (CAD) or myocardial ischemia.

Based on your history, you have experienced episodes of arrhythmias, including atrial fibrillation, and have had recent symptoms such as palpitations, shortness of breath, and chest discomfort. These symptoms, particularly the episodes of rapid heart rate (tachycardia) and irregular heartbeats, raise concerns about your cardiovascular stability. The fact that you have been to the emergency department multiple times for these issues indicates that your heart rhythm has been unstable, which is a critical consideration before undergoing any stress testing.

The myocardial perfusion scan typically involves inducing stress on the heart, either through exercise or pharmacological agents like dipyridamole or persantin. For patients with a history of significant arrhythmias, there is a risk that the stress induced during the scan could exacerbate these conditions, leading to further complications such as sustained tachycardia or even more severe arrhythmias. Therefore, it is crucial to ensure that your heart rhythm is stable before proceeding with the test.

In your case, the recent episodes of skipped beats and the significant heart rate increase to 129 beats per minute, along with your symptoms of shortness of breath and chest discomfort, suggest that your heart may not be in an optimal state for undergoing a stress test. Additionally, the swelling in your left arm and under your collarbone following the Moderna vaccine could indicate a localized reaction, but it is essential to discuss this with your healthcare provider to rule out any potential cardiovascular implications.

Given these considerations, it is advisable to have a thorough discussion with your cardiologist before proceeding with the myocardial perfusion scan. Your doctor may recommend monitoring your heart rhythm more closely or adjusting your medications to stabilize your condition before considering the scan. They might also explore alternative diagnostic methods that do not involve stress testing if your arrhythmias remain a concern.

In summary, while a myocardial perfusion scan is a valuable tool for assessing heart health, your current symptoms and history of arrhythmias suggest that it may be prudent to delay the scan until your heart condition is more stable. Always prioritize open communication with your healthcare provider, as they can provide personalized recommendations based on your specific health status and needs.

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