Re: Post ("aborted"?) MI data . . .

convicted neighbor Tdub wrote:

I'm only concerned about "grade 1 diastolic dysfuntion" noted early
on, followed 8 months post-MI of "mildly reduced tracer activity in
the inferior wall of the left ventricle . . . gated SPECT imaging
demonstrates normal myocardial thickening and wall motion . . . the
calculated left ventricular ejection fraction is > 70%. IMPRESSION:
MYOCARDIAL PERFUSION IMAGING IS NORMAL. THE AFOREMENTIONED PERFUSION
ABNORMALITY IS DUE TO SOFT TISSUE ATTENUATION" (from Bruce dual
isotope; Exercise Stress Testing + SPECT Myocardial Perfusion).
Cardio's follow up report to my primary care physician indcated "no
evidence of irreversible defects". Does this mean I completely dodged
the bullet?

No.

It means that Someone pushed you out of the way of a bullet, thereby
sparing your life.

Was this what is called an "aborted" MI?

This would be a small MI. You did lose some heart muscle cells based
on your troponin elevation.

Do I have any (residual heart) defects?

The scarring would be for life. However, the fact that your LV
systolic function is preserved despite the myocardial infarction would
give you an overall excellent prognosis for full recovery.

Please, no "prayers, god or convict" junk.

You would be wise to thank HIM for your favorable outcome. It was HIS
doing.

------------------------------------

Full summary of post-MI testing:

Indication: Anginal MI; myocardial infarction with ST elevation
(STEMI)

Cath lab report:

Coronary circulation: Severe 1-vessel coronary artery disease (LAD).
Proximal LAD: 100% stenosis just after S1. TIMI grade 0 flow through
the vessel (no flow).

Cardiac structures: Severe apical septal hypokinesis. Global left
ventricular function normal. EF calculated by contrast
ventriculography 63%.

Intervention: Cypher stent 2.5 x 28mm; balloon angioplasty performed
on the 100% lesion in the proximal LAD.

Hemodynamics: normal arterial pressure.

Ventricles, regional contractile function: severe apical septal
hypokinesis. Global left ventricular function normal.

Coronary vessels: Circulation right dominant. Distal LAD: Discrete 60%
stenosis. Proximal circumflex: discrete 20% stenosis. Mid circumflex:
tubular 20% stenosis. 1st obtuse marginal: Vessel large sized.
Angiography showed no evidence of disease. RCA: The vessel was small
(non-dominant). Proximal RCA: Diffuse 20% stenosis.

Troponin levels: +.5 day: 11.80 ng/mL; +1 day: 12.30; +1.2 day: 7.57;
+3.2 day: 3.54

----------------

(+.75 day) ECG: T wave abnormality, consider lateral ischemia;
Abnormal ECG; Compared to ECG of
+.5 day, T wave inversion now evident in Lateral leads.

(+1.75 day) ECG: T wave abormality, consider anterolateral ischemia;
Prolonged QT; Abormal ECG; Compared with previous ECG (referenced
above) T wave inversion more evident in Anterolateral leads

(+8 weeks) ECG: (In report of cardiologist to primary care physician
(referencing previously noted anterior wall hypokinesis): NO WALL
MOTION ABNORMALITIES + NORMAL LV FUNCTION (is this correct, with grade
1 diastolic dysfunction noted in +7 weeks Transthoracic ECG).

----------------

(+1 day) Transthoracic ECG:

Left ventricle: Systolic function normal. Ejection fraction estimated
in the range of 55% to 65%. Akinesis and scarring of the apical
anterior, apical inferior, and apical wall(s). Severe hypokinesis and
scarring of the mid anterior and apical septal wall(s). Doppler:
increased relative contribution of atrial contraction to ventricular
filling. Doppler parameters consistent with abnormal left ventricular
relaxation (grade 1 diastolic dysfunction).

Mitral valve: Mild annular calcification.

This is a tell-tale sign of coronary atherosclerosis.

Wall thickness normal.

This is reassuring.

----------------

(+7 weeks) Transthoracic ECG:

Everything cleared up from +1 day Transthoracic ECG except:

(Left ventricle ejection fraction 55% to 65%)
Abnormal left ventricular relaxation (grade 1 diastolic dysfunction).

It is likely that your cardiologist elected not to comment on the
scarring which does not go away.

----------------

(+8 months)
Bruce dual isotope
Exercise Stress Testing + SPECT Myocardial Perfusion:

Everything normal, including stress ECG negative for ischemia, except:

Mildly reduced tracer activity in the inferior wall of the left
ventricle. Gated SPECT imaging demonstrates normal myocardial
thickening and wall motion. The calculated left ventricular ejection
fraction is > 70%. IMPRESSION: MYOCARDIAL PERFUSION IMAGING IS NORMAL.
THE AFOREMENTIONED PERFUSION ABNORMALITY IS DUE TO SOFT TISSUE
ATTENUATION.

This too should reassure you.

May GOD bless you in HIS mighty way making you healthier (hungrier)
than ever.

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
Cardiologist

.