Your Heart Health: Insights from Your Myocardial Perfusion Scan

Examination Report

Hello Dr.
Lee, this is my examination report.
I would like to ask if it would be better to proceed with a cardiac catheterization.
Thank you!
TI-201 Myocardial Perfusion Scan: The patient has experienced recent chest tightness.
A Tl-201 myocardial perfusion scan was performed with dipyridamole stress.
Dipyridamole 0.57 mg/kg was administered intravenously over 4 minutes.
Tl-201 2 mCi was injected 2 minutes after pharmacological stress.
Imaging commenced 5 minutes and 4 hours after injection using SPECT.
Images were reconstructed using iterative reconstruction techniques and displayed in multiple transaxial planes and 3D views.
1.
Anterior wall: Normal uptake.
2.
Septal wall: Abnormal uptake; reversible.
3.
Inferior wall: Abnormal uptake; partially reversible.
4.
Lateral wall: Normal uptake.
5.
Apical wall: Normal uptake.
Lung uptake: Normal.
L/H ratio: 0.37 (stress), L/H ratio: 0.31 (rest).
NUCLEAR CARDIOLOGY DIAGNOSIS:
1.
Mild ischemia in the apical-inferior and basal-anteroseptal walls.
2.
Stress LVEF: 70%, Rest LVEF: 70%.

Ming, 40~49 year old female. Ask Date: 2023/01/13

Dr. Li Han reply Cardiology

Hello, based on your inquiry, the abnormal Tl-201 myocardial perfusion scan indicates suspected mild ischemic changes in the apical inferior wall and the basal anterior septal region, but myocardial contraction is normal and there are no other high-risk features.
The nuclear medicine physician has no further recommendations.
This type of functional stress test cannot accurately localize coronary artery disease anatomically; it can only provide a semi-quantitative risk stratification based on the degree and extent of blood flow redistribution defects.
If your cardiologist has initially suspected less than 50% likelihood based on your clinical symptoms, this test may raise the suspicion of coronary artery disease to 80%.
For patients in the intermediate to high-risk category, further invasive coronary angiography may be recommended.
Of course, there are many considerations that may lead to such a recommendation.
It would be advisable to discuss the data report directly with your cardiologist for further clarification.
The Changhua Hospital of the Ministry of Health and Welfare cares about you.

Reply Date: 2023/01/13

More Info

Understanding your heart health is crucial, especially when interpreting the results of a myocardial perfusion scan. Based on the details provided in your report, it appears that you have undergone a Tl-201 myocardial perfusion scan following a dipyridamole stress test due to recent episodes of chest tightness. This type of test is designed to evaluate blood flow to the heart muscle and can help identify areas of ischemia, which is a condition where blood flow (and thus oxygen) is reduced to a part of the heart.

Key Findings from Your Report:
1. Wall Uptake: The anterior wall shows normal uptake, while the septal and inferior walls exhibit abnormal uptake. The abnormal uptake in these areas is described as "reversible," indicating that the ischemia is not permanent and may improve with increased blood flow.

2. LVEF: Your left ventricular ejection fraction (LVEF) is reported as 70% both during stress and at rest, which is within the normal range. This suggests that your heart's pumping ability is adequate, even though there are areas of ischemia.

3. Lung Uptake: The lung uptake ratios are normal, which is a positive sign as it indicates that there is no significant congestion or other issues affecting the lungs.

Implications of Your Findings:
The presence of mild ischemia in the apical-inferior and basal-anteroseptal walls suggests that there may be some degree of coronary artery disease (CAD) affecting blood flow to these regions. Given that the ischemia is reversible, it may be indicative of conditions such as stable angina, where the heart muscle is not receiving enough blood during periods of increased demand (like exercise or stress) but can recover when the demand decreases.

Next Steps:
1. Discussion with Your Cardiologist: It is essential to have a thorough discussion with your cardiologist regarding these findings. They will consider your symptoms, risk factors, and overall health to determine the best course of action.

2. Further Testing: Your cardiologist may recommend further testing, such as a coronary angiogram (heart catheterization), to visualize the coronary arteries directly. This procedure can help identify any blockages or significant narrowing in the arteries that may require intervention, such as angioplasty or stenting.

3. Lifestyle Modifications: Regardless of the immediate next steps, adopting a heart-healthy lifestyle is crucial. This includes a balanced diet low in saturated fats and cholesterol, regular physical activity, maintaining a healthy weight, and managing stress. If you smoke, quitting is one of the most significant steps you can take to improve your heart health.

Conclusion:
While your myocardial perfusion scan indicates some areas of concern, the overall assessment of your heart function appears to be stable at this time. The decision to proceed with further invasive testing should be made collaboratively with your healthcare provider, considering all aspects of your health and personal circumstances. Regular follow-ups and monitoring are essential to manage your heart health effectively.

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