Your Heart Health: Insights from Recent Cardiac Tests

Cardiac-related examination report?

Hello, Doctor He.
A few years ago, I underwent coronary artery stent placement.
Recently, I had follow-up tests including a myocardial perfusion scan and echocardiogram.
The reports are as follows:
Myocardial Perfusion Scan:
- The baseline ECG showed right bundle branch block.
There were no ST-T changes during dipyridamole infusion.
- The initial and 4-hour delayed images showed: (1) moderate to severe reversible perfusion defects at the basal septum, anterior, lateral, and inferior walls; (2) transient post-stress left ventricular (LV) dilatation; (3) the lung-heart ratio was within normal limits.
- Visual semiquantitative analysis (5-point scale in AHA 17-segment model): summed stress score (SSS) = 24, summed stress percent (SS%) = 35%.
- Gated SPECT (8 frames per cardiac cycle estimated by QGS method):
- Post-stress LVEF = 42%; resting LVEF = 49%.
- Post-stress LV end-diastolic volume (EDV) = 103 ml, end-systolic volume (ESV) = 60 ml; resting LV EDV = 82 ml, ESV = 42 ml.
- Regional wall motion: transient post-stress global hypokinesia.
Echocardiogram:
- Dilated left ventricle.
There are regional wall motion abnormalities as specified.
The LV systolic function is preserved.
The transmitral spectral Doppler flow pattern is suggestive of impaired LV relaxation.
- Aortic regurgitation: mild-moderate.
Mitral regurgitation: mild-moderate.
Tricuspid regurgitation: mild.
Pulmonic regurgitation: mild.
Pulmonary hypertension: mild.
I would like to ask the doctor if these two reports indicate any serious issues.
Is there a need for further cardiac catheterization? Additionally, regarding the echocardiogram results showing valve insufficiency, how serious is this condition? Is further treatment necessary? Thank you, Doctor, for taking the time to answer my questions.

Ben, 70~79 year old female. Ask Date: 2022/04/01

Dr. He Dongjin reply Cardiology

Hello, if there are more serious issues with your myocardium, further cardiac catheterization may be necessary.
The situation regarding valve insufficiency is not severe and can be monitored for now.
Changhua Hospital cares about you.

Reply Date: 2022/04/01

More Info

Based on the recent cardiac tests you underwent, including the myocardial perfusion scan and echocardiogram, there are several important insights regarding your heart health that can be drawn from the findings.

Myocardial Perfusion Scan Findings
1. Reversible Perfusion Defects: The scan indicated moderate to severe reversible perfusion defects in the basal septum, anterior lateral, and inferior walls of the heart. This suggests that there are areas of the heart muscle that are not receiving adequate blood flow, particularly during stress. The term "reversible" indicates that these defects may improve when the heart is at rest, but they still signify underlying issues that need to be addressed.

2. Left Ventricular Function: The left ventricular ejection fraction (LVEF) post-stress was reported at 42%, which is significantly lower than the normal range (typically above 55%). The resting LVEF of 49% also indicates compromised heart function. These values suggest that your heart is not pumping efficiently, which can be a concern for heart failure or other cardiac conditions.

3. Transient LV Dilation: The report noted transient post-stress left ventricular dilation, which can occur when the heart is under stress and is not able to maintain its normal shape and function. This can be indicative of underlying ischemic heart disease.

Echocardiogram Findings
1. Dilated Left Ventricle: The echocardiogram showed a dilated left ventricle, which can be a sign of heart failure or other cardiac conditions. A dilated ventricle may struggle to pump blood effectively, leading to further complications.

2. Regional Wall Motion Abnormalities: The presence of regional wall motion abnormalities aligns with the findings from the myocardial perfusion scan, reinforcing the idea that certain areas of the heart are not functioning properly.

3. Valvular Regurgitation: The echocardiogram indicated mild to moderate regurgitation in the aortic, mitral, tricuspid, and pulmonic valves. While mild regurgitation may not always require treatment, moderate regurgitation can lead to symptoms and may necessitate closer monitoring or intervention, depending on the severity and your symptoms.

4. Impaired LV Relaxation: The Doppler flow pattern suggests impaired left ventricular relaxation, which can be a sign of diastolic dysfunction. This means that while the heart may contract well, it may struggle to fill properly, leading to increased pressures in the heart.

Recommendations
Given the findings from both tests, it is advisable to consider further evaluation through coronary angiography (heart catheterization). This procedure can provide a clearer picture of the coronary arteries and help determine if there are blockages that need to be addressed, especially given your history of coronary artery stenting.

Severity of Valvular Issues
Regarding the valvular regurgitation, while mild to moderate regurgitation may not be immediately concerning, it is essential to monitor it closely. If you experience symptoms such as shortness of breath, fatigue, or palpitations, further evaluation and potential treatment may be necessary. Regular follow-ups with your cardiologist are crucial to assess the progression of these conditions.

Conclusion
In summary, the results from your myocardial perfusion scan and echocardiogram indicate several areas of concern, including reduced left ventricular function, reversible ischemia, and valvular regurgitation. It is essential to discuss these findings with your cardiologist, who can provide a comprehensive plan for further evaluation and management, including the potential need for coronary angiography and monitoring of your valvular function. Maintaining a healthy lifestyle, adhering to prescribed medications, and attending regular follow-up appointments will be vital in managing your heart health moving forward.

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