Hi doctor, During a routine medical checkup, I had something wrong with my ECG (resting) and was recommended to go with echo 2D and TMT. I do not have any chest pain. My 2D echo report is fine. However, TMT was done and the report is as follows. Significant ST depression of 0.1 mm in leads V4 - V6 at peak exercise not persisting in recovery. TMT mildly positive for RMI. Bruce test parameters were Bruce stage 3, exercise time 8.09 minutes, METS-10.2 and THR attained -173 bpm. BP 120/80 mmHg during resting and recovery. Maximum BP during exercise was 140/80 mmHg. I did not have any problems during my TMT. I went to a doctor to understand the implications. He told me that TMT result is incorrect and it should not be mildly positive as it does not match with the parameters given above with the report. Rather, it should be negative for TMT. As a result, I was advised to undergo TMT again for my satisfaction which I took after six days of the first test. I am enclosing the copy of the report. As per analysis of this report, the doctor has said that it is negative for RMI. However, one more doctor has told me that this analysis is incorrect and even this report reflects mildly positive for RMI. As a result, I am confused about the authenticity of the report and its interpretation by doctors. I would request you to go through the 11 pages of report which I am enclosing and please let me know whether the report can be declared as negative for TMT. Please let me know if I need to provide any other information. Also, please advise further action that I should take. Thanks. Is there any test which can confirm or deny the possibilities of a heart related problem?
Hi. Thanks for providing a detailed case history. I have reviewed every bit of the case aids provided here (attachment removed to protect patient identity) and can realize your issues. Based on these reports, we cannot say you have a coronary artery disease that may have been occlusion 75% or more of the heart's arteries. As you do not have chest pain, neither at rest nor at exertion, I do not think you need an angiography at the moment. You do not need an angiography right away. If ever in future, you feel pain in chest that is confirmed to be the cardiac pain in origin, then your cardiologist may need straight to go for an angiography to see the cause of this pain. For further information consult a cardiologist online -->