Moderate perfusion abnormality

[R_N]

I just had an MPI.  I was scheduled for this because I've been consistently in bigeminy/trigeminy for a couple of years.  I am asymptomatic and the bigeminy was caught during a routine visit.  The nurse detected an irregular pulse and did an EKG which revealed the bigeminy.  Since then, I'm more in bigeminy or trigeminy than a regular rate.  My heart rate also runs in the high 40s to low 50s, occasionally jumping up to the 60s and 70s.

I used to be very physically active, running a couple miles a day, lifting weights, etc, so the low heart rate was normal for me.  However, because of bad knees and ankles, I am no longer that active.  I try to do as much as I can, but every step hurts.  I've even been told by an orthopedic physician that I should limit my walking so I can limit the damage being done to my joints.

Back to the MPI.  I had that instead of a TMT because of the issue with my joints.  I was in bigeminy throughout the MPI.  My maximum heart rate was in the 80s.  The only symptom I had following injection was a mild shortness of breath that lasted about 5 seconds.  During the imaging,  I had to lie prone because the radiologist wasn't getting good images with me in bigeminy in a supine position.  Initial report from the radiologist shows large, moderate severity reversible abnormality in the apex, inferior and septal walls.

My questions.  Is there a chance this is an inaccurate reading based on being in bigeminy and prone?  I realize there is a chance of inaccuracy when read as a mild perfusion abnormality, but this was definitely read as moderate.  Being asymptomatic, should I consider any further, more intrusive tests (like PCI)?

And the big question.  What could be causing this?  I am a vegetarian (have been for 15 years), slightly overweight (I'm 6'0" 215 lbs somewhat muscular), non-smoker, drink a glass of red wine 3-4 times a week, no immediate family history of cardiac issues.  I have had pain issues (lower joints) for several years and cannot take NSAIDS due to a sensitive stomach.  This leaves me with taking tramadol and hydrocodone/apap for pain control, which I've been on for several years.  All of my lab results are within normal range and have been for several years, including HDL and LDL.

Thanks for any help with this matter.

[ed34]

I know how you feel, I went through something very similar myself. My situation was different only in the sequence of events. I had a heart attack for which a stent was implanted, but it was noticed how badly diseased my left artery was at the time and no intervention was done until further tests were performed. EKG tests always looked good, Echo scans were perfect, and nuclear perfusion scans showed an abundance of oxygen, and yet, my angiogram had shown very little blood supply through my left artery. This was backed up by my symptoms. Cardiologists actually said that if my heart attack hadn't occurred, hence the angiogram, then I would have been labelled as 'fit and healthy with no heart problems'. Frightening isn't it.

[R_N]

Thanks, ed34. I realize there are other factors, but I have none of those either. No family history and no stress. I'm already semi-retired. The only stress would be pain related and I've learned to live with that.

I did get the cardiology report today and there are a lot of inconclusives. They couldn't even determine the wall motion or EF. So, I'm not putting a lot into this test. It seems it didn't do anything other than muddy things up even more.

[ed34]

I'm not sure why a slightly abnormal heart rhythm would make it difficult to obtain images?
Regardless of this, the results do warrant further investigation and I understand what you are trying to say about your healthy lifestyle, but some people still get artery disease despite of this. My Cholesterol is very low, I eat a good diet and yet I recently suffered another heart attack due to another blockage. There are other things which are contributors, such as your genes and how much stress you endure in your life. It is also becoming very apparent from research that the immune system plays a huge role in the development of CHD and some people seem to have a far more aggressive immune system than others. Anything in life carries risk, even crossing the road, and an angiogram is actually very low in risk. I would have the test if requested to ensure there is not a more serious underlying problem. Think of it this way, is it worth waiting for a heart attack to find out?

[R_N]

Thanks for your comments.  I'm aware of the treatment options at this point.  My question is more along the lines of whether the reading could be inaccurate.  I have a followup appointment with my cardiologist to get the full story.  However, I have a feeling he might recommend a diagnostic cardiac catheterization and I'm not sure it's worth the risk considering I am asymptomatic.  I'm also not sure what medical treatment options there are since there's nothing to treat.  LIke I said, my LDL and HDL are within normal range, actually better than most people's.  My only issue is the bigeminy and that's asymptomatic as well and only discovered because of an irregular pulse.

[kenkeith]

Mild to moderate ischemia and no symptoms would not indicate any further testing.  Treatment would be to control lipid levels.  

The AAC guidelines for intervention is if the occlusion is 70% or less no treatment necessary.  If the occlusion is greater than 70% and there is chest pain (angina) treat with medication.  If medication does not relieve symptoms, then a stent implant.  If a stent implant is not doable because of size or location, etc., then a bypass.

I have had a 70% blockage (mild by usual standards) and for the past 7 years my angina is treated with a nitrate prior to going to the health center for a workout.  You may want to get a professional opinion from a doctor who has your complete medical history, concomitant health problems, etc.  I have provided possilble options available.

Thanks for your questrion and if you have any further questions or comments you are welcome to respond.  Take care,

Ken