Re: cardiac PET scan

John Wendel said:

Dr.Andew B.Chung I asked you simple questions and I think I deserve
honest answears even though PET with FDG and blood flow perfusion
agents is not usually done just to find out if a person has had an old
small heart attack.Thanks

The honest answer is that there is *no* test that is 100% for detecting
small heart attacks short of an autopsy.

Why are you looking for such a test?

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

John Wendel said:

Dr.Andrew B. Chung I think I didn't ask you if there was a test that is
100% for detecting small heart attacks,because I already know that there
is no such test. Questions were 1. If cardiac FDG is done first and the
result is negative,does than person also need to have IV resting blood
flow perfusion to rule out old small heart attacks?

No.

Quoted message said:

2. Is cardiac FDG
only enough for diagnosis of all old small heart attacks (< 1 cm > 0,5
cm)?Thanks

Yes.

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

Dr.Andrew B.Chung I do not know,but I think if a person wants to know if
he had any old small heart attacks in his life cardiac FDG would be the
best test (gold standard). Usually either cardiolitte or rubidium blood
flow perfusion scan is done first and it is only screning,that is,if
positive cardiac FDG is indicated and if negative cardiac FDG is not
indicated,but if cardiac FDG is done during the test does it matter much
whether cardiolite or rubidium is used during the same test?Thanks

John Wendel said:

Dr.Andrew B.Chung I do not know,but I think if a person wants to know if
he had any old small heart attacks in his life cardiac FDG would be the
best test (gold standard). Usually either cardiolitte or rubidium blood
flow perfusion scan is done first and it is only screning,that is,if
positive cardiac FDG is indicated and if negative cardiac FDG is not
indicated,but if cardiac FDG is done during the test does it matter much
whether cardiolite or rubidium is used during the same test?Thanks

Short of a post-mortem autopsy, there is not a gold standard for detecting a
small old heart attack. Clinical history with an EKG +/- echocardiogram is
better than FDG PET scan, imo.

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

John Wendel said:

Dr.Andrew B.Chung What happens if a person has a normal ECG (no sign of
infraction) and normal ECHO (no sign of infraction),but has clear defect
on resting cardiolite and resting rubidium scans?What's the diagnosis

Consider nuclear imaging artifact such as diaphragmatic or breast
attenuation.

Quoted message said:

and should FDG be used to look for the extent of heart muscle
damage?Thanks

Not in my opinion.

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

I would consider heart attack if FDG is positive since this person is
male and not fat,but if FDG is negative than I would consider nuclear
imaging artifect. Dr. Andrew B.Chung do you beleive that PET scan
provides the highest level of accuracy of any non-invasive test for the
diagnosis of coronary disease and heart muscle damage. 2. Do you think
that no other diagnostic test can more precisely assess myocardial
viability than PET FDG? 3. What causes insignificant smal heart attacks
that are less than 1 cm and do old insignificant small heart attacks
cause arhythemia,pac,pvc,chest pain,sob plus any other side effects?4.If
a person had several small heart attacks would then they be significant
and cause heart failure?5.Do small heart attacks lower ejection
fraction?Thanks

John Wendel said:

I would consider heart attack if FDG is positive since this person is
male and not fat,but if FDG is negative than I would consider nuclear
imaging artifect.

Nuclear imaging artifacts can happen anytime even in someone thin.

Quoted message said:

Dr. Andrew B.Chung do you beleive that PET scan
provides the highest level of accuracy of any non-invasive test for the
diagnosis of coronary disease and heart muscle damage.

If you mean highest level of specificity (true positives divided by all
positives), the answer would be no. The total clinical picture plus the
thoughts/wisdom of the involved physician(s) has the highest level of
specificity.

Quoted message said:

2. Do you think
that no other diagnostic test can more precisely assess myocardial
viability than PET FDG?

Yes.

Quoted message said:

3. What causes insignificant smal heart attacks
that are less than 1 cm

Atherosclerotic coronary disease.

Quoted message said:

and do old insignificant small heart attacks
cause arhythemia,pac,pvc,chest pain,sob plus any other side effects?

The underlying atherosclerotic coronary disease can cause those symptoms.

Quoted message said:

4.If
a person had several small heart attacks would then they be significant
and cause heart failure?

They can.

Quoted message said:

5.Do small heart attacks lower ejection
fraction?Thanks

If there have been several, they can.

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

John Wendel said:

Dr.Andrew B.Chung 1.If resting PET scan with FDG and rubidium can easily
detect old small heart attack that is 0.3--0.5 cm in size and SPECT with
cardiolite can easily detect an old heart attack that is greater than 2
cm what about half PET/half SPECT (fused) scan,what's the smallest old
heart attack that it can easily detect and, please be specific in
numbers,like for the above two scans? 2. Dr.Andrew B.Chung you asked me
why concern about old small heart attacks, if they are so small that
they can't be detected all the time and there are several of them,but
they can cause problems and even heart failure (if they exist) I think
it would be better to diagnose them with the best non-invasive cardiac
imaging scans.3.If no other test can more precisely assess myocardial
viability than PET FDG,would PET FDG also detect the smallest cardiac
dead muscle and thus heart attack?Thanks

Sounds like you have some issues that would be best discussed with a
cardiologist in person.

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

Dr.Andrew B.Chung I do not know if I understood you,but did you say that
EKG and ECHO are better tests for diagnosis of all old small heart
attacks than cardiac PET viability study?Thanks