No one will tell me what my MUGA scan means
Dear DrRich,
I have a question about hypokinesis. I had a MUGA scan done in May before I started chemotherapy for breast cancer. I've now finished chemotherapy and am about to start radiation treatments to the left breast. The chemotherapy drugs I had -- adriamycin and cytoxan -- aren't particularly friendly to the heart. The radiation won't be either. I only just found out that my pre-chemo MUGA scan was abnormal, showing moderate hypokinesis of the anterior wall of the left ventricle and of the septum. The LVEF was 49% at rest; no exercise study was done. My family doc can't explain what this means and neither can the radiation oncologist. My medical oncologist wouldn't show me the report and just kept telling me it was perfectly normal. I had to call while he was on vacation and request it from one of his back office staff. I don't want you to give me any medical advice, I just want to know if I am overreacting to ask for a follow up test and a consultation with a cardiologist before starting radiation. Thanks for your help. Ms. Smith.
DrRich replies:
Dear Ms. Smith,
My major concern here would be the apparent refusal of your oncologist to show you the report, telling you it was normal. At the very least, that is paternalistic behavior, if not deceptive.
The fact is, an ejection fraction of 49% is very near the normal range, and for your oncologist to choose to call it normal may not be all that incorrect. It's his/her unwillingness to discuss it frankly with you I'd be worried about.
Second, your family doc "can't explain what it means" - that in itself is acceptable. No doc knows ALL the answers. But to just say, "I don't know" and leave it at that - that IS unacceptable. He/she owes it to you to track this down, sort it out, and give you a full and accurate assessment of what it really means. For family docs, accomplishing this feat often means referring to a specialist.
The reason MUGA scans are used before cancer therapy is because some of the chemotherapeutic agents are toxic to the heart. Adriamycin is the most notorious offender. If your MUGA was abnormal before chemotherapy, a fuller cardiac assessment probably should have been done at that point. If you had chemotherapy after this abnormal baseline MUGA scan, you definitely need a follow-up study at this point. A cardiologist should also probably follow you if it is determined that your ventricular function really is abnormal.
In summary, you are not overreacting. You deserve a full and honest assessment of what (if anything) is the matter with your heart. You have every right to insist on it.
Best of luck,
DrRich
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