Myocardial Perfusion Issues: Diagnosis and Management Tips

What issues do I have with myocardial perfusion? How should I address them? Thank you very much. 🙏

Examination Date: 2023/08/21 16:09:45
Examination Summary: 26025: Stress & Redistribution Myocardial Perfusion Study with SPECT
Report Content:
History: Chest tightness or pain (+), Dyspnea on exertion (-), EKG (+) inferior QS.
Unable to perform treadmill exercise test due to exercise intolerance.

Risk Factors: Diabetes Mellitus (+), Hypertension (-), Dyslipidemia (+), Smoking (-), Family History (-).

Procedure:
1.
Intravenous injection of 10 mCi of Tc-99m sestamibi.

2.
Intake of a high lipid diet (e.g., egg) 20 minutes later.

3.
Acquire gated rest myocardial perfusion SPECT with CT attenuation correction.

4.
Intravenous infusion of 0.56 mg/kg dipyridamole (Persantin) 30 minutes after rest imaging.

5.
Intravenous injection of 30 mCi of Tc-99m sestamibi.

6.
Intake of a high lipid diet (e.g., egg) 20 minutes later.

7.
Acquire gated stress myocardial perfusion SPECT with CT attenuation correction.

Findings:
1.
A small-sized mild reversible perfusion defect in the apical anterior and apical-mid inferolateral segments.

2.
The Summed Stress Score (SSS) = 3 (4% of LV, 3/68).
The Summed Rest Score (SRS) = 1 (2% of LV, 1/68).
The Summed Difference Score (SDS) = 2 (3% of LV, 2/68).

3.
No dys-synchrony or regional wall motion abnormalities of the left ventricle were noted in this study.

4.
Post-stress Left Ventricular Ejection Fraction (LVEF) > 70%, post-stress Left Ventricular End-Diastolic Volume (LVEDV)/Left Ventricular End-Systolic Volume (LVESV) = 57/3 mL, rest LVEF > 70%.

Impression:
1.
Mild degree myocardial perfusion SPECT.

2.
High probability of Coronary Artery Disease (CAD) with mild ischemia in the Right Coronary Artery (RCA) (and Left Anterior Descending artery (LAD?) territory.

3.
Normal left ventricular systolic function.

Suggestion:
1.
Please correlate with clinical and echocardiographic findings.

2.
Medical treatment first.

Report Author Report Date: 2023/08/22 01:03:37

Leemay, 60~69 year old female. Ask Date: 2023/08/25

Dr. He Dongjin reply Cardiology

Hello, a report indicating mild hypoxia usually does not indicate a serious issue and should be monitored.
Changhua Hospital cares about your well-being.

Reply Date: 2023/08/25

More Info

Understanding myocardial perfusion issues is crucial for diagnosing and managing coronary artery disease (CAD). The myocardial perfusion scan, particularly using SPECT (Single Photon Emission Computed Tomography), is a valuable tool in assessing the blood flow to the heart muscle during stress and at rest. This imaging technique helps identify areas of the heart that may not be receiving adequate blood supply, indicating potential ischemia.

Diagnosis of Myocardial Perfusion Issues
The findings from your myocardial perfusion study indicate a mild reversible perfusion defect in specific segments of the heart, particularly in the apical anterior and apical-mid inferolateral regions. This suggests that there is some degree of ischemia, which is a condition where blood flow (and thus oxygen) is insufficient to meet the needs of the heart muscle. The summed stress score (SSS) of 3 indicates that approximately 4% of the left ventricle (LV) is affected, which is considered mild. The summed rest score (SRS) of 1 and the summed difference score (SDS) of 2 further support the notion that the ischemia is not extensive.

The left ventricular ejection fraction (LVEF) being greater than 70% during both stress and rest indicates that the overall pumping function of the heart is preserved, which is a positive sign. However, the presence of mild ischemia, particularly in the right coronary artery (RCA) territory, raises concerns about the potential for coronary artery disease.

Risk Factors and Clinical Correlation
Your history reveals several risk factors for CAD, including diabetes mellitus (DM) and dyslipidemia. These factors significantly increase the likelihood of developing atherosclerosis, which can lead to blockages in the coronary arteries. The absence of hypertension and smoking is beneficial, but the family history of heart disease could also play a role in your risk profile.

Given your symptoms of chest tightness or pain, along with the EKG findings indicating inferior QS, it is essential to correlate these imaging results with clinical symptoms and possibly further echocardiographic evaluations. The combination of imaging findings and clinical history is crucial for a comprehensive assessment.

Management Recommendations
1. Medical Treatment: The initial recommendation is to start with medical management. This typically includes medications such as antiplatelet agents (e.g., aspirin), statins for cholesterol management, and possibly beta-blockers or ACE inhibitors depending on your overall health status and specific symptoms.

2. Lifestyle Modifications: Alongside medication, lifestyle changes are vital. This includes adopting a heart-healthy diet, engaging in regular physical activity as tolerated, managing blood sugar levels if diabetic, and maintaining a healthy weight.

3. Follow-Up and Monitoring: Regular follow-up appointments with your cardiologist are essential to monitor your condition. This may include repeat imaging studies to assess the progression of any ischemic changes and to evaluate the effectiveness of the treatment regimen.

4. Consideration for Further Testing: If symptoms persist or worsen, or if there is a significant change in clinical status, further testing such as coronary angiography may be warranted. This invasive procedure can provide a direct view of the coronary arteries and help determine the need for interventions such as angioplasty or stenting.

5. Patient Education: Understanding your condition is crucial. Engaging in discussions with your healthcare provider about your symptoms, treatment options, and lifestyle changes can empower you to take an active role in managing your heart health.

In conclusion, while your myocardial perfusion study indicates mild ischemia, the overall assessment suggests that your left ventricular function remains intact. With appropriate medical management, lifestyle changes, and regular follow-up, you can effectively manage your risk for coronary artery disease and maintain a healthy heart. Always consult with your healthcare provider for personalized advice and treatment plans tailored to your specific needs.

Similar Q&A

Understanding Cardiac Perfusion Imaging: Insights and Recommendations

Hello, Doctor. In 2021, I experienced chest tightness and palpitations, with my heart rate usually slightly elevated at 90-100 beats per minute, so I sought treatment at Taichung Cheng Ching Hospital. The physician ordered a myocardial perfusion imaging test, but did not provide ...

Dr. He Dongjin reply Cardiology
Hello, mild perfusion abnormalities indicate that it's not serious. You can just take medication and observe, so there's no need to worry. Changhua Hospital cares about you.

Understanding Cardiac Health: Insights from Stress Tests and Myocardial Perfusion

Hello Doctor, I have been experiencing chest tightness and palpitations for the past year. I underwent two types of examinations at the hospital, and the recent myocardial perfusion scan report indicated blockage in the terminal blood vessels of the heart. The doctor prescribed B...

Dr. He Dongjin reply Cardiology
Hello, the myocardial perfusion report is abnormal. It's hard to say if there is a problem; it is very likely that there is no issue, but without further examination, who can know? If you take cardiovascular-related medications, you don't necessarily have to take them f...

Understanding Myocardial Perfusion Scan Results in Coronary Artery Disease

Examination Item: Tl-201 Myocardial Perfusion Scan 1. Stress Imaging: The stress imaging following intravenous infusion of dipyridamole and the post-dipyridamole SPECT images revealed moderate hypoperfusion over the apical septo-anterior and septal walls of the left ventricle (e...

Dr. Huang Yinghe reply Cardiology
Hello: The nuclear medicine examination shows moderate myocardial perfusion reduction, and the exercise electrocardiogram is also positive, indicating a certain degree of myocardial hypoxia, commonly associated with coronary artery stenosis (but these two tests cannot definitivel...

Managing Suspected Myocardial Ischemia: Patient Insights and Recommendations

Hello, I am the patient who just asked about angina. It seems that patients with frequent angina attacks cannot undergo nuclear medicine myocardial perfusion imaging. I get short of breath when I exercise and I'm a bit afraid of the exercise stress test. Would it be better f...

Dr. Wu Xueming reply Cardiology
A 24-hour electrocardiogram is not very helpful in assessing myocardial ischemia. Current medications, if they can control symptoms, are recommended to be continued.