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What Does Persistent Area Of Ischemia On My Two Nuclear Stress Tests Indicate?
Question: Hi, my name is XXXXXXX . (58yrs). I've had Nuclear Spect Imaging done 2008 and again 04/2014. Both results essentially the same: Small to moderate size perfusion defect that involves the anterior, anteroapical wall that appears reversible, possibly representing region of Adenosine induced myocardial ischemia. Left ventricular function is normal at 65%.
The test I have questions about is the recently performed CTA of the Coronary Arteries 04/21/2014:
Contrast-enhanced scanning was performed. Volume rendered 3-D CT coronary angiogram was reconstructed. Pre-contrast imaging was performed and calcific score was generated. The patient's calcium score is O.
Patient is right side dominant. No evidence for significant plaque formation is seen. No evidence for coronary artery stenosis is seen. The LAD and diagonals are patent. There is a patent marginal branch. No significant circumflex branch is visualized. The patient is, however, strongly right-sided dominant with vasculature extending to the left AV groove via the right coronary artery.
Patient is noted to have a moderate-sized hiatal hernia. No mediastinal hematoma is seen. No mediastinal adenopathy is seen.
Slices, which included the upper abdomen failed to attention any evidence for adrenal enlargement. Lungs are clear.
IMPRESSION: No evidence for significant coronary artery stenosis is seen. There is essentially atretic left circumflex. Patient is, however, strongly right-sided dominant. No evidence for significant coronary artery stenosis or plaque formation is visualized.
I'm relieved to finally know for certain that I have absolutely no blockages or plaques. Although, I don't understand why there is a persistent area of ischemia on my two Nuclear Stress Tests?
Could you give me your impression of the CTA? I would like to understand this 'absence of' circumflex artery. Would there be an area that is lacking full blood supply? Maybe that would explain some of my 'sub-par' symptoms, short of breath walking up hill, etc.??? thank you for your time. XXXXXXX .
The test I have questions about is the recently performed CTA of the Coronary Arteries 04/21/2014:
Contrast-enhanced scanning was performed. Volume rendered 3-D CT coronary angiogram was reconstructed. Pre-contrast imaging was performed and calcific score was generated. The patient's calcium score is O.
Patient is right side dominant. No evidence for significant plaque formation is seen. No evidence for coronary artery stenosis is seen. The LAD and diagonals are patent. There is a patent marginal branch. No significant circumflex branch is visualized. The patient is, however, strongly right-sided dominant with vasculature extending to the left AV groove via the right coronary artery.
Patient is noted to have a moderate-sized hiatal hernia. No mediastinal hematoma is seen. No mediastinal adenopathy is seen.
Slices, which included the upper abdomen failed to attention any evidence for adrenal enlargement. Lungs are clear.
IMPRESSION: No evidence for significant coronary artery stenosis is seen. There is essentially atretic left circumflex. Patient is, however, strongly right-sided dominant. No evidence for significant coronary artery stenosis or plaque formation is visualized.
I'm relieved to finally know for certain that I have absolutely no blockages or plaques. Although, I don't understand why there is a persistent area of ischemia on my two Nuclear Stress Tests?
Could you give me your impression of the CTA? I would like to understand this 'absence of' circumflex artery. Would there be an area that is lacking full blood supply? Maybe that would explain some of my 'sub-par' symptoms, short of breath walking up hill, etc.??? thank you for your time. XXXXXXX .
Brief Answer:
CTA findings are absolutely normal.
Detailed Answer:
Hello CCCCC
Thanks for writing to HCM
I have gone through your findings in detail.
CTA is absolutely normal in your case.CT heart is best for calcium scoring in coronary vessels.Its score is zero,it means there is no calcium containing plaques in coronary vessels.All coronary vessels are patent.There is no block in any coronary vessels.
Circumflex artery arises from left coronary artery and it supplies posterolateral left ventricle and anterolateral papillary muscle.It is atretic means it is not congenitally developed.You shouldn't worry about this.Its supply area are absolutely normal and it is supplied by right coronary artery.
Small to moderate size perfusion defect in SPECT is due to stress induced by adenosine injection.It may be due to spasm of vessels during exertion.These are reversible changes.Your ejection fraction is absolutely normal,So your heart condition is fine.
Your present symptoms are also related to exertion.You should avoid strenuous activities.
You should take treatment for hiatus hernia.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX
CTA findings are absolutely normal.
Detailed Answer:
Hello CCCCC
Thanks for writing to HCM
I have gone through your findings in detail.
CTA is absolutely normal in your case.CT heart is best for calcium scoring in coronary vessels.Its score is zero,it means there is no calcium containing plaques in coronary vessels.All coronary vessels are patent.There is no block in any coronary vessels.
Circumflex artery arises from left coronary artery and it supplies posterolateral left ventricle and anterolateral papillary muscle.It is atretic means it is not congenitally developed.You shouldn't worry about this.Its supply area are absolutely normal and it is supplied by right coronary artery.
Small to moderate size perfusion defect in SPECT is due to stress induced by adenosine injection.It may be due to spasm of vessels during exertion.These are reversible changes.Your ejection fraction is absolutely normal,So your heart condition is fine.
Your present symptoms are also related to exertion.You should avoid strenuous activities.
You should take treatment for hiatus hernia.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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