What is profusion defect with reverse redistribution?

Question

After a stress test was performed my brother was told he needs a cath of the heart because of a profusion defect or reverse reditrubution. What does this mean?

Answer 1

Schumaker is mostly correct, however there is a phenomenon called "reverse redistribution".

Simply put, they inject a radioactive substance that is bound to an active chemical into the blood stream. As the blood flows past the heart muscle cells, this compound is uptaken by them. The substance then releases a tiny dose of radiation. A (Gamma) camera then scans across the surface of your chest and picks up this "glow" of radiation. A computer then generates a 3D redering of what this glow looks like from all angles.

In a normal rest study all the muscle should light up. If you take a heart and "cut" it in cross section the image will look like a doughnut. The muscle on the outside and a "hole" in the middle where the pumping chamber cavity is. So if all the muscle lights up you should see a whole "O".

A normal stress study, where there is adequate blood flow to all the muscle also shows up as an "O". If there is a partial blockage there will be a section that does not light up and looks like a doughnut with a bite taken out of it. Kind of like a "C". then we compare these images and decide what is going on.

So, in a normal scenario you see:
Rest "O" Stress "O"

In ischemia you see:
Rest "O" Stress "C"

In infarct, with permanent muscle damage you see:
Rest "C" Stress "C"

The tricky part is in reverse redistribution you see:
Rest "C", Stress "O"

they call it reverse redistribution becouse it looks opposite to what you owuld expect in a positive study. After all why should you have abnormal flow in a rest study , but have normal flow during periods of stress when blood flow usually is compromised.

the reason for this has to do with the way the compiter generates the image. It "sees" abnormalities where they don't exist. Its actually a computer error causing theis phenomenon. the technical term is attenuation artifact, if its due to a "shadow effect". Or from "leaching" of counts from overaccumulation in neighboring areas. It gets very technical from there...

Most reverse redistribution studies are in fact normal. But you need another test to confirm, such as stress echo or coronary angiogram.

There is one other reason for this effect, which has to do with the binding properties of a particular compound thallium. But its beyond the scope of this forum to delve into that....

Suffice it to say if they used Technicium SestaMIBI, its probably a normal heart. And if they used Thallium, its probably a very abnormal heart with diffuse disease. His cardioogist will know what to do with the test results.

Hope that helps.

Answer 2

This is a typical result from a nuclear stress study. I think you might have some of it wrong though. It is more typical in the following language - a moderate profusion defect of moderate distribution. I have read a lot of those studies and I don't think I have ever come across "reverse redistribution."

Regardless, this refers to a difference in profusion of the stress study as compared to the resting study...aka inducible ischemia. In plainer language it is a definable area of the heart that is getting inadequate blood supply under stress conditions. It relates to an artery that is not supplying enough blood due to a artheriosclerotic plaque. A cath will figure out how much blockage is there. A blockage of 70% or more will usually warrant an angioplasty and a stent. Anything less than that will probably be treated with medication only.

An anology - the stress test gives you the neighborhood of the possible problem, the cath gives you the street name and the address. A cath is simply a more invasive study to determine what if anything needs to be done. About 50% of the time nothing needs to be done. Nonetheless, with a positive study, further investigation is warranted.

I hope this helps. Good luck to you and him.

Answer 3

A cardiac perfusion scan measures the amount of blood in your heart muscle at rest and during exercise. It is often done to find out what may be causing chest pain. It may be done after a heart attack to see if areas of the heart are not getting enough blood or to find out how much heart muscle has been damaged from the heart attack

It might mean that the artery might be closing and having an effect on his heart. If he is a heart patient it is possible for this to happen.

My husband is one. It did happen but it was more because he was stressed out.

I would suggest your brother speak with the dr and have a long talk with him. His dr should have told him every little detail.

I left a link to webmd, but you can also call the hospital and speak with the nurse who is answering the telephone.