Stress Test results

[cb3228]

I'm 55 and heading into have a cardiac cath in two days and was wondering if anyone can decipher some of this.  When I spoke to my dr., I was caught off guard by the phone call and didn't have the report in front of me obviously.....so didn't ask questions I would have had I seen it.  First, I've had pitting edema about 2 months ago that got to the point in my right leg that I couldn't wear my shoe and was also diagnosed diabetic.  I immediately started the KETO diet on January 1 and have since lost 17 lbs and started exercising also.  My swelling improved, but the burning and tingling continued in my feet and I also started having some chest fullness and pretty bad leg pain when using the elliptical that went away when stopping.  EKG has poor R wave progression and non specific ST-T wave changes.  I have High blood pressure controlled with meds and father passed at 61 from clot after 6 bypasses.  He had a massive heart attack and his mother passed at 55 from a heart attack.  My mom also passed from a stroke.  Previous echo showed mild regurgitation in mitral, pulmonic, aortic and tricuspid valves, non specific mitral, aortic and tricuspid leaflet thickening, mild concentric left ventricular hypertrophy and grade 1 diastolic dysfunction,

I was able to get to 86% of my predicted max heart rate and completed 7.0 METS.  Leg distress, Dyspnea and light headedness during test.  No dysrhythmias.  Poor R wave progression and non-specific ST &T wave abnormality.
Imaging quality is adequate, Excessive intestinal/hepatic uptake is present.  Corrected patient motion.  Adequate county density.
Resting perfusion images show small mild, mid to distal anterior defect.
Stress Perfusion images show anterior defict stillsmall and mild, but more prominent and slightly larger on stress imaging.
Gated images.....there are no regional wall motion abnormalities.  Normal ejection fraction ranges from 50 to 70%.  The calculated LV ejection fraction is 83%
Right ventricle does not appear dilated.  Right ventricular systolic function appears normal.
Other findings:  End diastolic volume 37 ml.  End systoic volume 6 ml.  TID score 0.90
My questions:  ejection fraction of 83% is abnormal?  Is the heart working overtime because of LVH and that's why?  The distal anterior defect is in resting and stress images.........does that mean damage was already done to that part, albeit small of the heart?  Does it mean i've had a previous MI (silent)?   If so the damage is in the front of the heart he told me on the phone...anterior(?) so would the likely blocked artery be the LAD?  He seemed quite worried (me too!) and reiterated that I was too young to have this going on and that due to my syptoms, the family history and results of the Stress test that I needed to have the cath done.  During a cath are they always able to stent the artery open?  How bad would it have to be for them to go to a bypass instead of a stent?  Sorry for so many questions, just very anxious.  Thanks so very much.  :)

[tacolino]

Hi there. I can understand how scared you must be.
Im not a doctor but will try help you a little.

Firstly you say you have high BP. Its controlled, but you dont quote numbers?
There are no BP numbers in stress results?
This is an important starting point.

Its not all bad. The right side is normal plus there are no wall abnormalities. Valves seem not too bad either!

The R wave issue can be caused by 3 or 4 different things. One of them is LVH. Thats why I asked about BP numbers to start. Its critically important that the BP is strictly controlled, particularly given the added complication of your Diabetes.
High BP is a major cause of LVH.

Its not clear that you have a blockage ?.
Regarding blockages, in Ireland the normal rule of thumb is as follows;
Part blockage up to 70% - Medication treatment
Over 70% - Medication or Stenting, if its possible
100% blockages- Total Blockages can now often be treated by stenting, depending on the patients particular condition.
Bypass surgery can be done in difficult cases or where there are complex multiple blockages.

Your EF is a little high, but I would not get hung up on this.
Of course the fluid retention will increase strain on your system and along with your diabetes, needs careful monitoring.
Its great that you have lost some weight and I encourage you to keep it up. Take a medium term view and you will reach your goal.

Get a pen and paper. Write out all your questions for your Cardio and ask them exactly what you have written down.
In the meantime dont panic! Try chill a little.

[bobthom]

On the ejection fraction, it's only an estimate.  Imagine a clear plastic bag full of water, you squeeze the bag so water comes out, then visually, by looking at the size and shape of the bag while being squeezed, you estimate how much water came out as a percentage of how much water was in it.  Generally, anything between 50% and 75% is normal, most say around 66%. A MUGA scan gives a much more accurate measure.  The catherization will give them a much more accurate view of all the major arteries in your heart and they can determine what will need to be done.  Generally, blockages less than 50% are left alone but need to be monitored, up to 75%-80% usually can be stented, 100% blockages generally require bypass.   As for the damage to the heart, it may not be a blockage, it could be scare tissue damage or an electrical impulse issue, that's why they are doing the cath.  I have no blockages yet have EF 17% and stress test images show severe damage and restricted perfusion.  If it is a blockage, and they can stent it, you should be pretty much back to "normal" shortly after.
Disclaimer:  I am NOT a doctor.  Do not rely on my opinion or advise.  Consult a licensed professional.  Batteries not included.  Some assembly required.  Oh, and just for fun, ask your cardiologist if his work comes with a lifetime warranty!  As serious and stressful as this all is, please try to maintain a sense of humor.