I had a nuclear stress test. interpetation says spect images demonstrate a small mild intensity reversible perfusion defect involving the distal anterior wall which suggests ischemia in the lad. what does this mean?

That means your cardiac symptom is likely due to coronary heart disease (a small branch of the left anterior descending artery, LAD, has significant blockage so that a small area of your heart is not perfused well with blood, i.e. ischemia, during stress). That lesion should be fixed if accessible if your symptom(s) can't be controlled with medication(s). Good luck.