Wondering about Heart Rate and Cardiac PET Stress Test results

[curious74432]

I am a 64 year old, white, female, not really active, but don't just sit all day.  Have been feeling fatigued and short of breath for quite a while.  Pulmonary dr. did Pulmonary Function Test and Chest CT Scan, all good there.  I saw my cardiologist and he ordered a nuclear PET stress test. Results follow.  I have noticed on my PCP records that over the past 3 years or so my resting HR is in the 70's or 80's at their office.  Bad cardiac family history.  I also have mitral valve insufficiency; scheduled for echocardiogram on 02/26/2020.  Any reason to be concerned?    
Reason for Appointment
1. PET - SP
Vital Signs
Wt 150 lbs, Ht 61 in, BMI 28.34 Index, BP 106/66 mm Hg, HR 70 /min, Oxygen sat % 99 %.
Examination
Stress Test:
       Nurse: Bill Farmer, RN.
       Technologist: Robin Jones, CNMT.
       Ordering Physician:  Dr. Pasupuleti.
       Interpreting Physician: Dr. Pasupuleti.
       Study Quaility: Good .
       Procedure: Cardiac Positron Emission Tomography: The patient underwent a stress test utilizing 0.4mg of IV Lexiscan infusion over 10-15 seconds. The patient experienced stomach pressure during the procedure and received no medications. The patient had a myocardial perfusion imaging performed using same day imaging protocol, with the injection of 30.0 mCi of Rubidium-82 at 30 seconds into Lexiscan infusion, and the injection of 30.0 mCi of Rubidium-82 at rest. Imaging was performed by gated resting and gated stress technique ,.
       Data Summary:
        TID: 1.06
        Resting EDV: 47
        Resting ESV:5
        Resting EF:88%
        
        Stress EDV: 47
        Stress ESV:4
        Stress EF: 92%
        
        Baseline BP:103/66
        Baseline HR:70
        Peak Stress BP:76/46
        Maximum HR Achieved:94 .
       Exercise Level: N/A .
       *Pre-Stress EKG: Normal Sinus Rhythm .
       *Stress EKG: Normal Sinus Rhythm , No ST changes.
       *Arrhythmias observed  None .
       *Resting Left Ventricle size Normal .
       *Peak Stress Left Ventricle Size Normal .
       *Right Ventricle appears Normal .
       *Post stress global LVEF is  Normal .
       *FINDINGS:
        1. small reversible myocardial perfusion defect noted in the basal anterior wall (area of reversible ischemia 3%).
        2. Normal wall thickening.
        3. Normal LV systolic function..
       *CONCLUSIONS:
        1. small reversible myocardial perfusion defect noted in the basal anterior wall (area of reversible ischemia 3%). Low risk stress test.
        2. EF 88%
        3. Normal LV systolic function..
Assessments
1. Anginal equivalent - I20.8

[ayl291]

What answers are you looking for?

[curious74432]

Just if my heart is pumping OK.  I have tried reading about the EF and it sounds like numbers over 70 are concerning.  Not sure, just looking for some idea of what is considered bad as far as high EF.  I read 50 and lower is very concerning.  Thanks for any insight.

[ayl291]

At first glance... you do have very mild ishemia but its reversable so my gut is that its arterial spasms.

The ef is too high imo... i would think hypertrophy of the ventricles but for some reason they said it looked fine?  So, its something id inquire about ... diastolic dysfunction.

The othet thing thats slightly odd is that your heart rate really did not elevate much.

Those are just my thoughts... I would talk to your provider and seek another opinion to feel more confident.

[curious74432]

Thanks for the information.  I found some notes from a prior Echocardiogram that I am pasting here.  It mentions mild pulmonary hypertension.  Just had another echo but do not know what it says yet.  Your thoughts on this old echo would be appreciated.   Reason for Appointment
1. Patient follows up from September 2017 for chest pain and valvular heart disease.
History of Present Illness
LVEF Recordings:
       Based on -  ECHO.
       Ejection Fraction
          Result (%)  60
          Date :  04/19/2018
Electrocardiogram (ECG):
       The electrocardiogram (ECG) was done for cardiac evaluation 09/15/2016.
Follow-Up Visit Note:
       Patient is a 62-year-old female
       With history of valvular heart disease, hypertension and hyperlipidemia comes today for follow-up.
       Since last appointment she has been doing very well and denies any symptoms of orthopnea PND. No symptoms of exertional chest pain or exertional dyspnea. No symptoms of palpitations. No episodes of syncope.
       She had an echocardiogram last year at Shands hospital and I reviewed the report. LVEF is 65% with trace MR and mild pulmonary hypertension. I discussed the test results with her.
       She was switched from atorvastatin to rosuvastatin and since then both her LDL and triglycerides have improved. She denies any further episodes of angina.
Vital Signs
Wt 159 lbs, Ht 61 in, BMI 30.04 Index, BP 98/83 mm Hg, HR 83 /min, Oxygen sat % 98, Wt-kg 72.12.
Examination
General Examination:
       GENERAL APPEARANCE: in no acute distress, alert.
       NECK/THYROID: neck supple, full range of motion, no cervical lymphadenopathy .
       HEART: regular rate and rhythm, S1, S2 normal, no murmurs .
       LUNGS: clear to auscultation bilaterally .
       ABDOMEN: soft, nontender, nondistended, bowel sounds present, normal .
       Extremities no clubbing, cyanosis, or edema .
       NEUROLOGIC: nonfocal, motor strength normal upper and lower extremities .
Assessments
1. Mitral valve regurgitation - I34.0 (Primary)
2. Chest pain - R07.9
3. HTN (hypertension) - I10
4. HLD (hyperlipidemia) - E78.5

[ayl291]

These are kind of opposite to what you have going on now...

Have you had a right heart cath to rule out pah?