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Nadim Al-Mubarak
Nadim Al-Mubarak, Doctor
Category: Cardiology
Satisfied Customers: 379
Experience:  MD at University Hospital Case Medical Center
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I recently had a stress test and it showed "a small fixed

Customer Question

I recently had a stress test and it showed "a small fixed apical thinning" - can you tell me in layman's terms what that means?
JA: The Cardiologist will need to help you with this. Please give me a bit more information, so the Cardiologist can help you best.
Customer: I went into my PCP for a physical. Before arriving and after I arrived I was having some chest pain/pressure. He gave me a baby aspirin and a nitrostat (which seemed to alleviate the pain/pressure) and sent me immediately to a cardiologist. He conducted a nuclear stress test and his findings indicate a "small fixed apical thinning". I have minor hypertension and am treated for it with 5 mg. of Lisinopryl, otherwise I am in pretty good health. What else do you need.
JA: I'm sure it's really worrying even thinking you might have a heart condition. I think our Expert will put your mind at ease and tell you what you need to do next to make sure nothing bad happens. Is there anything else the Cardiologist should be aware of?
Customer: I really don't worry about a cardiac condition but I wonder if I might have had a minor MI in the past. Apparently my cardiologist feels I am in pretty good shape now.
JA: OK. Got it. I'm sending you to a secure page on JustAnswer so you can place the $5 fully-refundable deposit now. While you're filling out that form, I'll tell the Cardiologist about your situation and then connect you two.
Submitted: 1 year ago.
Category: Cardiology
Expert:  Dr. Phil, MD replied 1 year ago.

Thanks for this question

This just means that the muscle in the bottom of your heart might not be getting enough blood

The muscle is weakened or thinned out due to lack of blood

you might need a cardiac cath to look at the blood vessels supplying that area of the heart with blood.

Customer: replied 1 year ago.
Thank you
Expert:  Dr. Phil, MD replied 1 year ago.

you're welcome :)

please don't forget a positive rating. I appreciate it

Expert:  Dr .Saeed ahmed replied 1 year ago.

Thank you for your question, This means that apex of the heart is thinned out and is due to lack of blood flow, In such cases there is no need for cardiac cath as muscles are already non viable of weak and even if you open the artery in this area with a stent it will not help this area. Best option is to use medicine like trimetazidine, last but not the least if ejection fraction of heart is low then it can be helped with a pacemaker called CRT to help improve the heart function. I am assistant professor in cardiology and can help you further.

Expert:  Dr. Phil, MD replied 1 year ago.

need more help?

Expert:  Nadim Al-Mubarak replied 1 year ago.


  • Technically speaking, "fixed defect and thinning" on a nuclear stress should mean "scar tissue", which is dead heart muscle from an old heart attack that is transformed to scar. But, this is unlikely to be the case here
  • Clinically speaking (which is most important), the description above means nothing is wrong with your heart. " Small and Apical" is a vague and unrealistic description used by some physicians interpreting nuclear studies when they inappropriately "Over-interpret" them. And, it is not supported by any pathoanatomical basis. An analogy, it is like saying " small area of the tip of your nose has a problem"
  • Even if we suppose it is true, this amount of "scar tissue" will not impact on your heart function and you do not need any Pacemaker or CRT. And, you do not need a heart catheterization
  • Let me know if you need any further clarification