Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Are Angiography And Stents Necessary If TMT Reports Show ST Depression In Inferolateral Leads?
Question: Hi, Iam 58 year old male, underwent CABG four years ago in 2014 for 99% lesion in ostial LAD and 30% in distal LMCA. LCX had distal 30% lesion. Two grafts had been done to LAD and LCX. Now my current TMT shows mild ST depression in inferolateral leads which normalised during recovery. There is no angina arrhythmias. I completed the whole 10 min of TMT test without any problem. I am also mostly asymptomatic but sometimes with slight tightness of chest. All other tests like Echo and lipid profile are normal. Doctor only prescribed Tab Ranolaz 500mg two times daily and changed to Rosuvas from Tonact 10mg. My concern is whether I should go for an angio and get stented for any blocked arteries or go with medication only. During my first angio,my RA had mild ostial plaque.
Brief Answer:
Not absolutely necessary
Detailed Answer:
Hi,
Since you largely being asymptomatic, it's not advisable to undergo angiography at present.
Can you please upload the whole TMT report because if it's just in inferior leads, we don't consider it to be positive and in lateral leads we need either horizontal or downsloping st depression.
So I didn't exactly get by mild st depression. And you didn't have any symptoms during while TMT and echo are also normal, so these things do not suggest the need for angiography and stenting.
Non-significant st depression may occur in minor blockages at some places.
Also, there is no added benefit of stenting in patients like you other than symptomatic relief which is not an issue for you.
So overall, I don't think that angiography is necessary. At XXXXXXX you may under some other modality of tests like either a stress thallium or ct coronary angiography whichever is available for clearing this mild st depression dilemma.
Hope I have answered your query. Let me know if I can assist you further.
Not absolutely necessary
Detailed Answer:
Hi,
Since you largely being asymptomatic, it's not advisable to undergo angiography at present.
Can you please upload the whole TMT report because if it's just in inferior leads, we don't consider it to be positive and in lateral leads we need either horizontal or downsloping st depression.
So I didn't exactly get by mild st depression. And you didn't have any symptoms during while TMT and echo are also normal, so these things do not suggest the need for angiography and stenting.
Non-significant st depression may occur in minor blockages at some places.
Also, there is no added benefit of stenting in patients like you other than symptomatic relief which is not an issue for you.
So overall, I don't think that angiography is necessary. At XXXXXXX you may under some other modality of tests like either a stress thallium or ct coronary angiography whichever is available for clearing this mild st depression dilemma.
Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks for your reply. As requested, I have uploaded TMT and Echo report for your reference and advise.
Brief Answer:
TMT is positive.
Detailed Answer:
Hi,
I have gone through the reports. TMT is positive, but still, I don't think there is any need for angiography at present.
Firstly, you didn't have any symptoms despite running up to stage 4, so you should have got some symptoms at such a high Level of exertion if significant blockages were present.
This ST depression may be seen due to some minor blockages which can't be treated during bypass surgery.
Did you have any negative TMT post bypass? If yes, we can give some significance to the report.
So I think medicines should be good enough.
But, since TMT is positive, it's better you undergo some other modality of test like either Stress thallium to see the extent of perfusion defect or CT coronary angiography where bypass graft can be visualized better, whichever is available.
It's not urgent. So you discuss these with a local doctor. All the best.
Hope I have answered your query. Let me know if I can assist you further.
TMT is positive.
Detailed Answer:
Hi,
I have gone through the reports. TMT is positive, but still, I don't think there is any need for angiography at present.
Firstly, you didn't have any symptoms despite running up to stage 4, so you should have got some symptoms at such a high Level of exertion if significant blockages were present.
This ST depression may be seen due to some minor blockages which can't be treated during bypass surgery.
Did you have any negative TMT post bypass? If yes, we can give some significance to the report.
So I think medicines should be good enough.
But, since TMT is positive, it's better you undergo some other modality of test like either Stress thallium to see the extent of perfusion defect or CT coronary angiography where bypass graft can be visualized better, whichever is available.
It's not urgent. So you discuss these with a local doctor. All the best.
Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks for the reply. I didn't have any negative TMT post CABG. I have been undergoing TMT test every six months post CABG and the current TMT only shows mild ST depression after almost 4 years. Does the ST Depression shown in current TMT indicate any particular Artery where there may be minor lesion. I want to know whether perfusion defect lies in grafted arteries and other arteries. As long as I don't have symptoms, I can postpone angiography. But I want to understand How risky it is to postpone.
Brief Answer:
See the description.
Detailed Answer:
Hi,
So basically your previous TMTs were negative and this is the first one with a positive report, right.
So in that case, it better to get some other test done before going ahead directly with major angiography. CT coronary angiography would be better.
From ST depression, we can't exactly pinpoint the arteries involved but its likely a circumflex artery territory.
Likely, blockages may be in the native vessel only as graft blockages would be symptomatic and TMT would be strongly positive.
Regarding risk, if medicines are continued properly then there is not a striking difference between medicines and stenting.
Stenting will provide symptomatic relief which you don't have. So there is not much difference in risk in you between two options. So I think, nothing Emergency.
Hope I have answered your query.
Take care
Regards,
Dr Sagar Makode, Cardiologist
See the description.
Detailed Answer:
Hi,
So basically your previous TMTs were negative and this is the first one with a positive report, right.
So in that case, it better to get some other test done before going ahead directly with major angiography. CT coronary angiography would be better.
From ST depression, we can't exactly pinpoint the arteries involved but its likely a circumflex artery territory.
Likely, blockages may be in the native vessel only as graft blockages would be symptomatic and TMT would be strongly positive.
Regarding risk, if medicines are continued properly then there is not a striking difference between medicines and stenting.
Stenting will provide symptomatic relief which you don't have. So there is not much difference in risk in you between two options. So I think, nothing Emergency.
Hope I have answered your query.
Take care
Regards,
Dr Sagar Makode, Cardiologist
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Kampana
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
