Complicated: Meaning of Perfusion Defects?

[KimC]

Hello,

I mentioned this in my earlier post, but am looking for insight into the results of my thallium stress test.

According to the findings, I have a 11% perfusion defect under stress and 2% defect at rest. (If Dr. Marty's reading this post, would you please give me some straightforward insight into what exactly this might indicate?)

I was told I have "normal" maximal perfusion. What does this mean? How can the results be normal if defects were found? I'll try not to speculate, but perhaps my cardio meant "normal" for someone with moderate AI. Or perhaps defects are normal in the general population???

I also will try not to drive myself crazy until I can speak to my cardio next week, but would a malfunctioning aortic valve "skew" the results, in other words indicate a "false-positive" for CAD or perfusion defects?

Secondly, if 2% of my wonderful heart is not getting enough nutrients at rest, then what does this mean? If it's evidence of cell death, then I'm wondering if I shouldn't push for a valve replacement. Thoughts?

I'm concerned that over time this percentage will grow ...

Finally, I know many of our members have asked this question: valve disease is pathological, meaning it damages the heart over time. We know that it can ultimately cause heart failure that's usually reversible w/ surgery.

But can heart tissue regenerate? In other words, once an area of your heart dies, is it dead for good? Does valve disease destroy tissue??? (Sorry to be morbid).

I was also told that based on the results, a cath w/ ergovine (sp?) may be indicated, as I am low-risk for CAD but coronary vasospasms are more likely. I also understand that spasms can damage the heart over time, and may be related to the malfunctioning valve. (My family, especially my father and brother who are neurosurgeons, are strongly opposed to a cath due to the risks. They want me to wait until the AI is severe and surgery is absolutely indicated, which could take years).

I hope you don't mind my candor. I'm looking for the truth based on your experience or insights, not feel-good answers. I've had enough of those!

Peace,

 

[ccrawford]

Hi Kim - I'll venture an answer but please get the straight scoop from your cardio. A perfusion defect found after exercise but not at rest is an indication that one or more cornoary blockages are preventing sufficient blood from reaching your heart. After a rest period, enought blood will reach the area of the heart in question so that living pericardium cells will survive. On the other hand, a perfusion defect at rest is an indication that ischemia has occurred and that there is now an area of scar tissue on the heart because of lack of coronary blood flow. I suppose that a valve problem could contribute to reduced coronary blood flow, but typically, it is due to plaque buildup in the coronary ateries, or due to a clot. While I venture this last sentence, be assured that its more of a guess based on things I have seen and heard. I hope this helps. Let us know how it goes next appointment. Chris

 

[KimC]

Thanks, Chris. Great to hear from you. How are you these days? I hope spring arrives early in Hoosierland.

I had the thallium test while hospitalized in December and had to cut in short due to severe SOB.

Afterwards, I overheard the residents discussing it with a negative tone. Apparently they determine risk for CAD and "future events" via EF, number and extent of perfusion defects.

I wasn't told that I had ANY defects but could tell by the tone of the residents that they weren't telling me the whole story. I have great people instincts.

When I asked why I lost stamina on the treadmill, (duh) they told me I must have had an anxiety or asthma attack! (I've never had either).

My cardio at the Cleveland Clinic shared the full results with me, then sent me the images for my files. He said I have "maximal perfusion," which means my EF is 77% at peak stress, which is a good indication that my heart is compensating well, but that there are signs of weaking. I didn't really know what he meant at the time or didn't want to think about it, (you know, shock).

After receiving the actual images and seeing the specifics just last week, I became more concerned. I hope I'm not overreacting.

I'll let you know what I hear later this week.

God bless,

 

[Marty]

Stress Test

Stress Test

Kim, Your test is abnormal but not real bad or dangerous in my view. I disagree a little with your Dad and brother but I'll give them a little slack because they are neurosurgeons and worse ,I am a radiologist. Sooner or later you will need cardiac cath. I'd vote for sooner so if your cardio recommends it, do it. Its really not so bad. I enjoyed watching my coronaries dance around on the TV monitor. The dye for most people is harmless and gives you a pleasant warm feeling. As always ,make sure the cardiologist or radiologist that does your test is expert and experienced. My test was done by my cardiologist not a radiologist. He is the interventional expert for his group of 24 cardiologists. The xray techs said he is the best in the hospital and gets beautiful pictures with minimal amounts of dye. That's the kind of doctor you are looking for.

 

[KimC]

Marty, you are the best! Thank you.

You can bet that I'll go to the expert for the cath. I'll head to O-HI-O!

Warm regard,