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Difficulty breathing, chest pain, LAD ischemia, abnormal myocardial perfusion imaging, history of myasthenia gravis. Treatment ?

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Internal Medicine Specialist
Practicing since : 2004
Answered : 73 Questions
You seem very knowledgable on heart matters,and I will welcome your advice..On the September 9,2011 I had an MPI. The results were abnormal . It stated that there is a large moderately severe defect involving the anterior,apex, anterolateral and mid inferior walls. Then it said, this is consistent with ischemia involving the LAD and/ or RCA questionably attenuation artifact. There was moderate breast attenuation. There was no significant motion during the acquisition. There was no transient LV dilitation noted. I would deeply appreciate any help in understanding this report. I do not see the cardiologist until Monday and I want to know what questions I might need to ask. I have only had minor chest pain but I have severe problems with breathing when I try to do any activity and fatigue. Thank you so much for your time!
Posted Fri, 4 May 2012 in Heart Attack
Answered by Dr. Sujeet N Charugulla 1 hour later

Thanks for your query.

I shall address your concern based on your current given information.

The Myocardial Perfusion Imaging (MPI) Report helps doctor to evaluate for coronary artery disease. (CAD)

1) The report says large moderately severe defects involving anterior, anterolateral and mid inferior walls walls-consistent with Left Anterior descending artery +/- right coronary artery ischemia. Attenuation?

The report describes coronary arteries and walls involved in ischemia. This is a bit concerning issue.
However attenuation of photons by the patient's body is responsible for one of the most prevalent artifacts in MPI and that is also seen in your case. A thorough clinical examination and corelation of other reports may help your doctor clear the doubts.

2) Breast attenuation -Breast attenuation usually results in a perfusion defect along the anterior wall of the Left Ventricle, although, depending on body habitus, the lateral wall, septum, and even the apex can be affected.

3) Left Ventricular dilatation - Dilatation means a certain level of failure.

A positive MPI test is one that demonstrates reversible ischemia. Information on the size of the perfusion defect has additional prognostic value. Manual or automated scoring systems have been validated and correlate with cardiac mortality. In addition, the results of MPI provide prognostic value independent of the treadmill ECG results.

Initial interpretation of test results is performed by a cardiologist and reported back to the ordering physician. Hence I suggest you to consult a physician / cardiologist.

I hope I have answered your concern on a broad sense, now. If you have additional questions, I will be available to address them.

Above answer was peer-reviewed by
Follow-up: Difficulty breathing, chest pain, LAD ischemia, abnormal myocardial perfusion imaging, history of myasthenia gravis. Treatment ? 14 hours later
Assuming this is an actual defect and not an attenuation artifact is it serious or just something mild. What is the diagnosis and how can it be treated? Thank you again for your time. Respectfully, Sky XXXXXXX
Answered by Dr. Sujeet N Charugulla 2 hours later

Thanks for the reply.

MPI test results would be meaningful only when correlated with the clinical status of findings. Even if your test has shown a hazy word like - "large moderately severe" it is a terminology of the pathological basis, and it may not always reflect the actual clinical condition though might serve as a guide. I can only say even if you have something serious in here but not certainly to panic.

Angina Pectoris (pain in the chest) and Myocardial infarction are 2 different entities and have different lines of management with drugs that have lot of promise.

Your inability to do any activity, before which you get breathless is a sign your heart is on the path of failure purely because of these ischemic findings that is not able to pump blood adequately to the required area. But, the intensity of the failure only can be assessed by your cardiologist.

I hope I have made a small attempt to throw light on what actually is happening with you.

I will be available for follow up queries if any.

Above answer was peer-reviewed by
Follow-up: Difficulty breathing, chest pain, LAD ischemia, abnormal myocardial perfusion imaging, history of myasthenia gravis. Treatment ? 4 hours later
Many thanks again, Dr. Charugulla. I appreciate all your help. What exactly is LAD Ischemia and how can it be corrected? Has my Myasthenia Gravis contributed to this problem? Thanks again for your valuable time, Sky XXXXXXX
Answered by Dr. Sujeet N Charugulla 4 hours later
Hello again ,

Thanks for the reply.

LAD stand for Left Anterior Descending artery. Also called by other names. But, what is important here is the fact that it is the main supply of blood to the left ventricle from the aorta (main artery) which is the pumping station of the whole body.

The treatment options include:
1. Medication (drugs)
2. Interventional Cardiology (CABG- Coronary Artery Bypass Graft)
3. Cardiovascular Surgery

As always, your cardiologist will decide the best option based on the clinical condition, and this will vary case to case.

Myasthenia gravis is an autoimmune disorder, that causes profound weakness in the muscles. Reasons are still u known, but antibodies exist.

Whether this is the culprit for LAD condition ?
NO. Myasthenia gravis complications include - myasthenic crisis, thymus tumours, pernicious anemia), thyroid problems. (You already have undergone these...)

You seem to be a fighter for your age with all this. I can only advice you from my end and would be glad to explain any further query you have and make it simple.

But, do get some holistic help from proper support groups in your city for your overall mental strength to help you to continue enduring all the health problems you have.

Take care,
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