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Forum Name: Ischemic Heart Disease

Question: Perfusion defect anterior septum


 NinoMalo - Fri Apr 17, 2009 7:22 pm

I am a 62 year old male with Hx of a three vessel CABG six years ago. At the time, I had been an endurance cyclist for eight years and went for a physical that included a treadmill test consisting of Bruce Protocol. The results were positive for significant ST segment elevation, blockages confirmed with heart cath and the operation was performed three days later. There were numerous complications following surgery including excessive bleeding, bilateral pulmonary effusion, congestive heart failure, abnormal liver and kidney function, right side heart enlargement and associated conditions such as pedal edema, ascities, etc. To make a long story short, with diet and exercise, I have made remarkable progress. My HDL is 42, my LDL is 59, triglycerides are 85, my EF is 67%, by B/P is in the 105/68 range and I demonstrated no signs of ischemia during my target heart rate during a recent nuclear stress test. Overall, there appeared nothing wrong EXCEPT the radiologist noted a "perfusion defect" in the anterior septal region before and after the treadmill test that was "suspicious" for an MI. This was based on the absence of this defect on an identical test two years ago. If I had an MI, I was certainly not aware of it and would have immediately contacted a health care provider if I had any of the signs of a possible MI. My question is if there is anything, other than an MI, that could cause such a defect? Are there false positives in this kind of test?
 John Kenyon, CNA - Fri Apr 24, 2009 8:23 pm

User avatar Hi there-

First of all congratulations on the great work you've done recovering from a traumatic CABG surgery. That's extremely impressive, and not everyone chooses (or is able) to accomplish what you have. Good work.

Now then: the most recent stress test/nuc scan showed an anterior septal perfusion defect called "suspicous for MI." Is it possible this could be a false positive? Yes. While the odds are less in favor of that than they would be in someone without the history you have, false positives can occur and do fairly regularly if not frequently. This is one possibility. Another is silent MI, which tends to occur mostly in diabetics and the elderly. You don't mention diabetes and are certainly not in the "elderly" class, so this seems fairly unlikely. A third possibility is that sometimes a defect can show up temporarily for reasons that are not clear, then resolve later. With no symptoms and only a "suspicous" possible post MI lesion, it would seem nothing much has happened in terms of practical application, and may not have happened at all. (I am familiar with appearance and subsequent disappearance of such lesions over a period of months or years in people with positive CAD histories. It can be perplexing). My advice would be to go with your cardiologist's recomendations regarding this finding. The radiologist is obligated to not everything and anything that isn't "to spec", even when there have to be other abnormalities which should be showing up as well. The very fact that just prior to your CABG you had ST segment elevation would suggest a possible infarction. There may have been a borderline injury that shows up now in the course of remodeling. Again, followup with your cardiologist is the important thing here. It could absolutely be a false positive -- or false possible positive, since it may be concluded this was artifact when your doctor has looked at the pictures. We do see false positives on a fairly regular basis, athough I don't know what the exact statistics are for this.

With no symptoms and significant improvement in all areas I wouldn't be overly concerned, and would expect the cardiologist would make an issue of this if he felt it deserved it.

I hope this is helpful to you. Good luck and please follow up with us as needed.

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