Re: cardiac PET scan

Dr.Andrew B.Chung I know that small heart attacks do not always show
up on any testing.I also know that normal resting cardiolite blood flow
perfusion rules out FDG PET use, but does normal resting (only)
cardiolite blood flow perfusion rules out all old small heart atttacks
that are less than 1--2 cm in size?Thanks

Dr. Andrew B.Chung I am sorry for using the word less than instead of
greater than 1--2 cm in size in my question.Thanks

[email hidden] (John Wendel) wrote in message news:<[email hidden]>...

Quoted message said:

Dr. Andrew B.Chung I am sorry for using the word less than instead of
greater than 1--2 cm in size in my question.Thanks

Cardiolite should allow a "scar" larger than 1-2 cm to show up as a
perfusion defect provided it is not obscured by soft tissue
attentuation (i.e. breast or diaghragm)

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Dr Andrew B.Chung I do not know how you got 99% for sensitivity in
detecting all old small heart attacks,because on family practice.com
says that the sensitivity by ECHO for transmural infraction is 90% and
for subendocardial myocardial infraction is 60--80%.Dr Andrew B.Chung
what do you think is the sensitivity by ECHO only,by EKG only,by resting
cardiolite blood flow perfusion only and when you add all three
together (for detecting all old small heart attacks) Thanks

John Wendel said:

Dr Andrew B.Chung I do not know how you got 99% for sensitivity in
detecting all old small heart attacks,because on family practice.com
says that the sensitivity by ECHO for transmural infraction is 90% and
for subendocardial myocardial infraction is 60--80%.

Add an EKG and an astute cardiologist to the Echo and you increase the
sensitivity.

Quoted message said:

Dr Andrew B.Chung
what do you think is the sensitivity by ECHO only,by EKG only,by resting
cardiolite blood flow perfusion only and when you add all three
together (for detecting all old small heart attacks) Thanks

The cardiolite will add little to the other two for an astute cardiologist
who takes a good history and conducts a good physical exam.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Andrew B.Chung as you know some cardiologists beleive that stress
echo provides information similar to cardiolite scan,however some
cardiologists beleive that cardiolite scan provides better information
than stress echo,because of blood flow to the heart muscle. Which stress
test (cardiolit or stress echo) has better accuracy in diagnosing CAD?
Which test (cardiolite without the stress part or stress echo) has
better accuracy in diagnosing all old small heart atacks >1<2 cm?Thanks

Dr.Andrew B.Chung As for adding EKG ,astute cardiologist and an Echo and
thus getting 99% sensitivity. I think if ECHO has 60-80% sensitivity in
detecting heart attack it would not be possible for astute cardiologist
to get 99% sensitivity?Thanks

John Wendel said:

Dr.Andrew B.Chung as you know some cardiologists beleive that stress
echo provides information similar to cardiolite scan,however some
cardiologists beleive that cardiolite scan provides better information
than stress echo,because of blood flow to the heart muscle. Which stress
test (cardiolit or stress echo) has better accuracy in diagnosing CAD?
Which test (cardiolite without the stress part or stress echo) has
better accuracy in diagnosing all old small heart atacks >1<2 cm?Thanks

Since noone else seems to be interested in this discussion, perhaps we can
move it to my chatroom at some point in the near future:

http://www.heartmdphd.com/chat.asp

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

John Wendel said:

Dr.Andrew B.Chung As for adding EKG ,astute cardiologist and an Echo and
thus getting 99% sensitivity. I think if ECHO has 60-80% sensitivity in
detecting heart attack it would not be possible for astute cardiologist
to get 99% sensitivity?Thanks

Ime, there have been instances where the clinical picture +/- EKG leads to
doubts about the initial reading on an echocardiogram leads to reexamining
or redoing the echocardiogram. This would be where the sensitivity
increases when an astute cardiologist is involved.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

John Wendel said:

D.Andrew B.Chung I do not know if I understood you, but did you say that
EKG has better sensitivity than Echo in diagnosing all old small heart
attacks

No, I did not write that.

Quoted message said:

and why would you want to redoe the same echocardiogram if it
is negative?

Because one suspects it is not truly "negative."

Quoted message said:

Would you also want to redoe EKG just because EKG says
Lateral ST elevation -repeat if myocardial injury is suspeced; consider
left atrial enlargement - otherwise normal EKG; Bordeline EKG etc?

If the quality of the EKG is poor (i.e. noisy) or if one suspects that there
were lead placement errors, yes.

Quoted message said:

Dr.
Andrew B.Chung I am not cardiologist,but what would EKG print at the top
of paper (tracing) if a person had an old smll heart attack?

It may say there has been a myocardial infarction or to consider it.

Quoted message said:

Would you
list examples of sentences? Would the code "ABNORMAL EKG" always show up
on EKG tracing?Thanks

That or borderline.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Andrew B.Chung If you suspect that echocardiogram is not truly
negative and you keep on and on redoing it and at the end the result is
a negative echo,but you still have doubt,because of EKG..... At the end
what would your diagnosis be and would you use EKG or ECHO result for
your final diagnosis?Would you use any other tests,like nuclear scans to
help you in your diagnosis of either one or several old small heart
attacks?Thanks

John Wendel said:

Dr.Andrew B.Chung If you suspect that echocardiogram is not truly
negative and you keep on and on redoing it and at the end the result is
a negative echo,but you still have doubt,because of EKG.....

It wouldn't be on and on. First, the study (with the actual acquired
images) is reviewed. If it is a good quality study, this is usually
sufficient to either affirm or refute the EKG and other clinical findings.

Quoted message said:

At the end
what would your diagnosis be and would you use EKG or ECHO result for
your final diagnosis?

Depends. Here is where the astuteness of the cardiologist factors into the
equation.

Quoted message said:

Would you use any other tests,like nuclear scans to
help you in your diagnosis of either one or several old small heart
attacks?Thanks

Only if the EKG is uninterpretable for MIs (ie when there is a left bundle
branch block or pacemaker dependence) and the echocardiogram is technically
poor.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Andrew B.Chung would cardiolite scan with an defect and a normal FDG
PET scan (no sign of any abnormality or defects) rule out old heart
attacks (dead muscle tissues)? If you add an normal EKG to the above
normal FDG PET would it than rule out old heart attacks (even though
there is an defect on cardiolite scan)?If there are any doubts (because
of cardiolite defects)what tests should next be used?Are there two types
of heart attacks:one with dead muscle tissues and other t guess with no
dead muscle tissues?What's the difference betwen them other than one
having dead muscle tisues and other not?Thanks

Dr.Andrew B.Chung if a male person 47 yrs old 6 foot tall 186 pounds
had a stress echo with B study quality and lasted for 15:15 minutes on
Bruce treadmill and achieved 15.8 METS and had an normal stress echo (no
sign of any old heart attacks) and a normal sinus rhythm EKG (with a
normal LV systolic and diastolic function and a stress echo results
negative for ischemia)..........What would the odds be that a small old
heart attacks < 1 cm and also >1 cm with the above test results were
not detected?Thanks

John Wendel said:

Dr.Andrew B.Chung if a male person 47 yrs old 6 foot tall 186 pounds
had a stress echo with B study quality and lasted for 15:15 minutes on
Bruce treadmill and achieved 15.8 METS and had an normal stress echo (no
sign of any old heart attacks) and a normal sinus rhythm EKG (with a
normal LV systolic and diastolic function and a stress echo results
negative for ischemia)..........What would the odds be that a small old
heart attacks < 1 cm and also >1 cm with the above test results were
not detected?Thanks

Near zero probability of old heart attacks either large or small.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Andrew B.Chung 1. Would cardiolte scan with an defect and a normal
FDG PET scan (no signs of any abnormality or defects) rule out old heart
attacks (dead muscle tissues) 2. If you add an normal sinus EKG to the
above normal FDG PET would it than rule out old heart attacks (even
though there is an defect on cardiolite scan) 3. If there are any doubts
(because of cardiolite defects) what tests should next be used? 4. Are
there two types of heart attacks: one with dead muscle tissues and the
other I guess with no dead muscle tissues? 5. What's the difference
between them other than one having dead muscle tissues and other not?
Thanks