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Done With Angioplasty. TMT Showed Positive For Ischemia. Do I Need An Angiography?

Posted on Mon, 17 Dec 2012

Question: My Angioplasty was done in XXXXXXX 2008. I am 62 yrs. male. I have no complaints.My BP is around 129/80.I underwent a medical exam on 20th Nov.,2012 for Immigration purpose. My blood, urine and chest x-ray were normal.Since my Angioplasty was done in the past, the examining physician referred me to to a Cardiologist for Cardiology clearance.My Echo and TMT were done.TMT was mildly positive for inducible ischemia. It was a good effort tolerance. with a work level of XXXXXXX METS 13.4 .Cardiologist advised me Angiography for cardiology clearance. I took second opinion from another Cardiologist. He suggested there is no need for Angiography.In TMT,Stage1 &2 BP was 140/90.Stage 3 & 4170/80.Recovery BP 140/70.
Kindly advise if I need Angiography.My TMT done in XXXXXXX 2009 also showed mildly positive for inducible ischemia at 10 METS workload. Then also no angiography was done.

Answered by Dr. Aslam Lalani (32 minutes later)

Hi,

Thanks for the query.

I have gone through the details submitted with diligence. It is my pleasure to answer you.

As per the TMT report, you have good effort tolerance as you walked on tread meal for 13.4 METS and your TMT is mildly positive - in this circumstance I will also go with second cardiologist. At present if I were to be your treating doctor, I will not advice for angiography.

However as you require a cardiac clearance for immigration purpose and since your last angioplasty was more than 4 years ago, I feel your first cardiologist has advice you to do angiography to give you the clearance. Therefore you may get it done for cardiac clearance purpose.

In the interim, please continue your medicine as before.

Hope I have answered your query. If you have any further questions I will be happy to help.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Aslam Lalani (16 hours later)

Dear Dr. Aslam,
Thanks for ur answer.
I m taking Atorlip10: 1 tab. daily,Clopivas 75: 1 daily,Ecosprin150: 1 daily, Metolar25: 2 daily.
I was medically examined on 20.11.12 for immigration purpose.The examining doctor found my blood, urine and chest Xray reports normal.Since my angioplasty was done in XXXXXXX 2008, I was refferred to a Cardilogist for Cardiology check-up.My Echo and TMT were done.Echo was reported to be: WNC. Tmt was mildy +for inducible ischemia.
Echo Interpretation comments:Normal LV systolic function.No LVH and no RWMA at rest.LVEF= 65%. Grade 1 LV diastolic dysfunction.LV,RV, Atria, Mitral Valve,Tricuspid Valve,Aprtic Valve pul. valve, Great Vessels,pericardium/pleural were normal in size/function. Cardiologist advised Coronary Angio. I was told that getting Angio was not mandatory. I did not express my wish for Angio as I am having no complaints. The examining doctor told me that they would send all medical reports/results to High Commission/Embassy.The Medical Board of High Commission would examine the reports and they have to take the decision.They can find it Ok or they can advise for corrective action/treatment. I want to know what is your assessment.Does my case show a low risk or high risk? Or is it a borderline/minor risk which can be ignored by the High Commission doctors?

Answered by Dr. Aslam Lalani (2 hours later)

Hi,

In my opinion your test reports is borderline or minor risk. However, to neglect it or to advice you for further test will be decided by high commission doctors only. They will take decision by guidelines provided to them and the guidelines may vary from country to country.
The medicines, which you are on at present, should be fine.
Hope I have answered your query. If you have any further questions, I will be happy to help.

Take care

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Mohammed Kappan