如何進一步評估心肌缺氧和心肌灌注狀況？-心臟血管專科

想請醫師幫看這份報告？

1.想請醫師看這２份報告心肌缺氧的狀況程度心肌灌注:The Tl-201 myocardial perfusion SPECT scintiphotos were performed at 5 minutes after intravenous injection of 2.5mCi Tl-201 with dipyridamole intervention ( 0.56 mg/Kg/4 minutes Stress ) and at 4 hours after redistribution ( Rest ). Result: The Thallium-201 Myocardial Perfusion SPECT Study with Dipyridamole Stress Intervention: Reverse Redistribution: Mid to Basal InferoLateral Wall, Mid to Basal Inferior Wall, Basal Septum. Mixed Myocardial Scarring with Ischemia: Basal InferoSeptal Wall, Basal Septum. Reversible Myocardial Ischemia: ApicoInferior Wall, Basal AnteroSeptal Wall. Severity of Lesions: Mild to Moderate Lesions. Most Prominent Lesions: Basal InferoSeptal Wall, Basal Septum, Basal AnteroSeptal Wall. Extent of Stress and Rest Defects: 2% and 6%. Transient Ischemic Dilatation ( TID ) Ratio: 1.03 ( Normal Reference: ＜ 1.22 ) Remarks: 1. All those parameters shown in this report of the imaging were derived from the ” Emory Cardiac Toolbox ” ( ECTb ), a software that has been approved by FDA ( USA ) for cardiac image decision support. However, please be advised that those parameters should be further correlated with clinical features. 2. Travain, et al, Semin Nucl Med. 1999;29(4):298: Sensitivities: 83%~97%: Specificities: 38%~94%. The overall sensitivity of MPI is about 80% to 90%. ( Essentials of NM and Molecular imaging 2019;5:146 ) 3. Reverse redistribution has been shown to associate with ( 1 ) post-myocardial infarction events and/or ( 2 ) chronic coronary disease ( vascular abnormaly, in appropriate wall motion, or decrease resting flow ); however, ( 3 ) normal variant also should be considered. 4. Since the low sensitivities might be shown in clinically high-risk cases, also the low specificities might be related to referral bias and technical artifacts. Please evaluate clinically and we would like to follow up closely.運動心電圖:Purpose: 1.(V) Dx; 2.( ) PTCA; 3.( ) PTMV; 4.( ) Drugs; 5.( ) CABG; 6.( ) Rehabilitation 7.( ) Arrhythmia; 8.( ) Screening; 9.( ) Others Pre-exceicise ECG: Blood Pressure:126 /79 Medications: ( ) Yes (V) No Patient Fasting ( ) Yes (V) No Stage: Speed/Grade(MPH/Grade): (1.7/10) (2.5/12) (3.4/14) (4.2/16) (5/18) Minutes: 2’ 5’ 8’ R2’ R5’ Blood Pressure: 140/71 146/70 149/67 153/71 140/73 Minutes: Blood Pressure: / / / / / Exercise Terminated Because of: A.( ) Maximal Effort F.(V) Dyspnea K.( ) Chest Tightness B.(V) 90% Maximal Heart Rate ObtaineG.( ) Arrhythmia L.( ) Can’t ctch-up speed C.( ) ST Segment Shift H.(V) Leg Pain M.( ) Exercise intolerance D.( ) Chest Pain I.( ) Hypotension N.( ) Vasovagal Response E.( ) Fatigue J.( ) Dizziness O. Total Time:10:37 MHR X MSBP: 166 X 149 = 24734 Maximal Achieved Rate: 166 Maximal Predicated Rate: 183 90% Predicated Rate: 163 INTERPRETATION OF EXERCISE ECG 1.( ) Normal ECG at maximal effort 2.( ) Normal ECG at submaximal(90%) predicated heart rate 3.( ) Normal ECG at ’inadequate’ heart rate of ( ) 4.( ) Abnormal ST junction and segmentelevated ( ) 5.(V) Abnormal ST segment depression: A. Downsloping ( ) mm ( ) B. Flat ( 1 ) mm ( in leads III, aVF and V4-6 ) C. Upsloping ( ) mm ( ) (from j point to at least 0.08 seconds) 6.( ) Other (Specialy): Comment: 1.(V) Positive 2.( ) Negative 3.( ) Inconclusive(specify) 4.( ) Complication(specify) 5.( ) Other: 製表者： 王薇華 報告醫師: 傅浩能 (中心專醫字S1957號)Purpose: 1.(V) Dx; 2.( ) PTCA; 3.( ) PTMV; 4.( ) Drugs; 5.( ) CABG; 6.( ) Rehabilitation 7.( ) Arrhythmia; 8.( ) Screening; 9.( ) Others Pre-exceicise ECG: Blood Pressure:126 /79 Medications: ( ) Yes (V) No Patient Fasting ( ) Yes (V) No Stage: Speed/Grade(MPH/Grade): (1.7/10) (2.5/12) (3.4/14) (4.2/16) (5/18) Minutes: 2' 5' 8' R2' R5' Blood Pressure: 140/71 146/70 149/67 153/71 140/73 Minutes: Blood Pressure: / / / / / Exercise Terminated Because of: A.( ) Maximal Effort F.(V) Dyspnea K.( ) Chest Tightness B.(V) 90% Maximal Heart Rate ObtaineG.( ) Arrhythmia L.( ) Can't ctch-up speed C.( ) ST Segment Shift H.(V) Leg Pain M.( ) Exercise intolerance D.( ) Chest Pain I.( ) Hypotension N.( ) Vasovagal Response E.( ) Fatigue J.( ) Dizziness O. Total Time:10:37 MHR X MSBP: 166 X 149 = 24734 Maximal Achieved Rate: 166 Maximal Predicated Rate: 183 90% Predicated Rate: 163 INTERPRETATION OF EXERCISE ECG 1.( ) Normal ECG at maximal effort 2.( ) Normal ECG at submaximal(90%) predicated heart rate 3.( ) Normal ECG at 'inadequate' heart rate of ( ) 4.( ) Abnormal ST junction and segmentelevated ( ) 5.(V) Abnormal ST segment depression: A. Downsloping ( ) mm ( ) B. Flat ( 1 ) mm ( in leads III, aVF and V4-6 )2.最早因為胸痛且健檢有血指偏高去看診，醫生叫我做了心肌灌注跟運動心電圖，目前醫院醫生只有開立普妥一天一顆，吃了兩個月後抽血數值有降回正常值，胸悶痛感也比較沒有出現，但最近又出現胸口有悶痛的感覺，回診後醫生聽心跳跟量心電圖說我可能只是筋膜痛，開胃藥跟肌肉鬆弛劑給我,但吃了兩天感覺沒有改善，想請問醫生,依據我的報告跟目前的狀況，我是否該去自費做更進步的檢查(電腦斷層或心導管),另外我的心率偏低(一分鐘大概50幾)，這是否跟我胸痛原因也有關呢？