心肌灌注檢查報告：需不需要做心導管？-心臟血管專科

心肌灌注檢查報告/請教主任是否需要做心導管？

請醫師幫忙看一下是否需要做心導管，感謝

REPORT OF NUCLEAR MEDICINE STRESS/REDISTRIBUTION MYOCARDIAL PERFUSION SCAN
CLINICAL HISTORY: 31-yr-old male is a case of chest tightness recently, - referred for detection of ischemic heart disease.
TECHNIQUE: Following the intravenous injection of 2 mCi of Tl-201 Chloride after intravenous administration of dipyridamole (Persantin) 0.56 mg/kg (maximal dose: 60 mg) in 3-5 minutes, SPECT imaging of the heart was performed using a Cardiac- centered CZT camera with ECG gating (8-frame acquisition). After an equilibration period of approximately 3-4 hours, the patient was imaged in a similar fashion while at rest. Single photon emission tomograms of left ventricle were reconstructed in horizontal and vertical long axis, as well as short axis projections. Bull' s eye analysis was performed on paired, registered (stress/redistribution) short axis images. Data of ECG-gated SPECT were analyzed and displayed. FINDINGS: (1) Perfusion defects of the left ventricle (LV) are noted: * Moderate perfusion defect at mid-to-basal lateral wall, with reverse redistribution (RR) & partial reversibility. * RR at anterior, inferior & apical lateral walls. (2) Lung uptake is normal. *Lung-to-heart ratio of stress: 0.25 * Lung-to-heart ratio of rest: 0.35 (3) Extent of perfusion defects by Bull' s eye analysis: * Stress → rest: LAD: 14%→ 29%, LCX: 44%→ 78%, RCA: 2%→ 6%. * Reversible defect: LAD 11%, LCX 31%, RCA 2%. * Fixed defects: LAD 3%, LCX 13%, RCA 0%. * Total perfusion defect: stress 17%; rest 37%; reverse 12% * Severity of perfusion defects: SSS of 2, SDS of 0. (4) ECG-gated SPECT results: * Stress/Rest LVEF: 53%/53%. * No obvious wall motion abnormality. IMPRESSION: Positive MPI study is summarized below: (1) Suspicious moderate ischemia at mid-to-basal lateral wall (2) Stress/Rest LVEF: 53%/53%; No wall motion abnormality. (Remark) * MPI (myocardial perfusion image) is focused on LV of heart.

brad，30~39歲男性，詢問日期：2023/12/18

吳學明醫師回覆-心臟血管專科

醫事人員經歷：衛生福利部桃園醫院心臟內科主任、臨床技能中心主任

檢查報告顯示心肌有缺氧現象，請與醫師討論是否需要做心導管。

回覆日期：2023/12/18
資料來源：台灣e院 - 心肌灌注檢查報告/請教主任是否需要做心導管

彙整補充說明

根據您提供的心肌灌注檢查報告，檢查結果顯示左心室中至基底側壁有中度的灌注缺損，並且有逆轉分佈的現象，這可能表示心肌缺血的情況。
報告中提到的「逆轉分佈」通常是指在壓力測試後，某些區域的血流灌注在靜息狀態下未能完全恢復，這可能是心臟血管狹窄或阻塞的指標。

在這種情況下，是否需要進一步進行心導管檢查（冠狀動脈造影）取決於幾個因素：
1. 症狀的持續性與嚴重性：如果您有持續的胸悶或胸痛，尤其是在運動或壓力下，這可能是心肌缺血的警示信號，建議儘快與醫師討論進一步檢查的必要性。

2. 檢查結果的解讀：報告中提到的中度缺血，尤其是在左心室的中至基底側壁，可能與冠狀動脈疾病（CAD）有關。
這種情況下，心導管檢查可以幫助醫師更清楚地了解冠狀動脈的狀況，評估是否存在狹窄或阻塞，並決定是否需要進行介入治療，如安裝支架或進行搭橋手術。

3. 其他檢查結果：報告中提到的左心室射血分數（LVEF）為53%，這在正常範圍內，但仍需考慮心臟的其他功能和結構狀況。
若有其他檢查（如心電圖、超音波等）顯示異常，則更應考慮進一步檢查。

4. 個人健康狀況：您的年齡、家族病史（如心肌梗塞）、生活方式等因素也會影響醫師的決策。
如果您有高血壓、高膽固醇或糖尿病等危險因素，這些都可能增加心臟病的風險。

總結來說，根據您的檢查報告，存在中度心肌缺血的情況，建議您儘快與主治醫師進行詳細討論，評估是否需要進一步的心導管檢查。
醫師會根據您的症狀、檢查結果及整體健康狀況來做出最合適的建議。
保持良好的溝通與定期檢查是維持心臟健康的重要步驟。
希望您能夠早日獲得適當的診療，祝您健康！

- 內容僅供參考無法取代醫師診斷 -