Brief Answer:
Positive TMT should not be ignored.

Detailed Answer:
Hi,
Welcome to HCM.

I have seen all the reports you attached here.From which,
2D echo is normal,
ECG shows T wave inversion in lead I,II and V4 to V6 with
TMT is mildly positive for inducible ischemia.

TMT Positive for "inducible ischemia" implies that there was significant ECG changes (ST depression) during the exercise which suggests that there exists a blockade in the blood vessels of the heart which is significant enough to restrict blood flow to heart muscles.So,it should not be ignored.

When a patient has positive TMT test but does not develop symptoms, we usually recommend an imaging based stress test (stress ECHO or stress thallium).

Sometime the ECG changes are too striking and we recommend coronary angiography straightaway.

Please also tell if you are having any other medical illness or family history of heart disease or if you have done lipid profile.

One more technical point is that the positive TMT and occurrence of heart attack are not entirely linked pathophysiologically.

A person with a positive TMT may not have heart attack for years together and a person with negative TMT may have an attack the same evening.

This is so because 'for TMT' to be positive there has to be a significant obstruction (usually more than 70%) but heart attack can occur on any degree of obstruction.

In fact most of heart attacks occur on pre-existing obstructions which are less than 70%. Hence the occurrence of heart attack can not be directly attributed to it.

So,in my opinion you should see DM cardiologist who might prescribe you blood thinner drugs (if he thinks) like ecosprin or clopidogrel considering your some positive TMT.

You should repeat ECG after 1 month of this medications to check for the response.

Till that time, coronary angiography (CAG) can be withhold or can be done only after cardiologist consultation.

Regards,

Dr.Sandip kabra

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