Dr.Andrew B.Chung if EKG and ECHO are better tests for diagnosis of all old small heart attacks than cardiac PET viability study, what would specificity and sensivity be for EKG and ECHO (TTE) and also for cardiac PET viability study?Thanks
Sensitivities and specificities of 99% and 99% would be expected for an astute cardiologist combining the information from an EKG and Echo with a good history and physical exam. Cardiac PET would be 90-95% and 90-95%.
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
[email hidden] (John Wendel) wrote in message news:<[email hidden]>...
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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 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
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.
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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 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
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:
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.
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.
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and why would you want to redoe the same echocardiogram if it is negative?
Because one suspects it is not truly "negative."
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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.
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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.
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Would you list examples of sentences? Would the code "ABNORMAL EKG" always show up on EKG tracing?Thanks
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
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.
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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.
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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 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
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 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
