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With Reference To The Test Reports Is It Necessary To Go For CT Coronary Angiogram?

Posted on Fri, 17 Jan 2014

Question: Dear Doctor, I have under gone following fitness test for Heart - 1. ECG - Sinus Rythhm....Normal, BorderLine T Abnormalities, inferior leads.... T flat/neg, II III aVF, BASELINE WANDER IN LEAD (s) V2 2.2D-ECHO WITH COLOUR DOPPLER - Impression : No regional wall motion abnormality, Left Ventricle normal in size! Normal left ventricular systolic foundation, Trivial Tricuspid Regularisation, No PE/CLOT/PLUMONARY ARTERY HYPERTENSION.. 3. Lipid Profile Test - cholesterol - Serum/plasma - 163 HDL CHOLESTEROL - 36 LDL CHOLESTEROL - 116 TRIGLYCERIDES - 133 Goal Cholesterol/HDL CHOLESTEROL - 4.5 4. Blood Glucose Fasting - 78 Blood Glucose Post Prandial - 92 5. TMT TEST - Impression - Cardiac Stress Analysis Mildly Positive for Inducible Myocardial Ischaemia at Good work load 91% of maximum heart REPONSE. BP response - normal Effort Tolerance - good Arrhythmia - NIL My question is that Doctor has suggested to do 320 CT coronary angiogram , is it necessary to do pls advice??? However, he has given following medicine course for time being.... - Immunace Forte - Atorfit CV 10/75 - Multivite Gold Would appreciate to please advise whether I should get done “CT CORONARY ANGIOGRAM"...., Truly Yours, XXXX XXXXXXX

Answered by Dr. Rakesh Karanwal (2 hours later)

Brief Answer: Coronary Angiogram not indicated at this stage Detailed Answer: Hi Mr. XXXXXXX Thanks for your query. 1. ECG and TMT reports, when interpreted together, are suggestive of an early stage of heart disease (coronary artery disease- CAD), where the blood supply to the base of the heart (called inferior wall of the heart) gets affected ONLY after moderately severe physical exertion ("at Good workload" - as per your TMT report). 2. In other words, narrowing of the arteries- supplying the base of the heart- is not significant enough to warrant any surgery in the near future. Under the circumstances, MEDICAL TREATMENT is the THERAPY OF CHOICE. 3. Hence, I am of the personal opinion that CT Coronary Angiogram at this stage would NOT contribute any significant information to that already known clinically, based on TMT findings. If I were your treating Physician/Cardiologist, I would have advised you against getting coronary angiogram done at this stage. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Col (Dr.) Rakesh Karanwal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (4 hours later)

Thanks Dr. Karanwal for advice which is highly appreciated. However, may I request you to suggest, what are medicine to be taken and continued as per the above medicine suggested by Doctor.. Secondly, what precaution to be taken care to improve the heart as this is an early stage CAD And trust this can be reversed.... Regards, XXXX XXXXXXX

Answered by Dr. Rakesh Karanwal (4 hours later)

Brief Answer: Treatment + precautions required, are given below Detailed Answer: Dear Mr. XXXXXXX Nice hearing back from you. * Continue with Atorfit 10/75. No other drug required at present, provided your blood pressure is less than 130/85. * Maintain your Blood pressure to less than 130/85. Your doctor will ensure this. * If overweight, bring down your weight to ideal level, that is, to BMI <25. * Regular exercises for at least 45mins/day * Well-balanced, LOW FAT, high protein diet. * As the case may be, stop alcohol, fried foods, junk food (pizzas, burgers, confectionary). I presume that you are a Vegetarian. * Regular medical check up, particularly if new symptoms develop. The above mentioned precautions will help in retarding the progress of CAD. Take care, Dr. (Col) Rakesh Karanwal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (17 hours later)

Thank you Doctor, - I do not take alcohol and pure vegetarian... - my blood pressure is within limit... - yes I am excess by 10kgs, will gradually loose weight.. Shall come back to you, if any further advise needed..

Answered by Dr. Rakesh Karanwal (6 hours later)

Brief Answer: My Pleasure, Mr. XXXXXXX Detailed Answer: You are welcome, Mr. XXXXXXX Dr. Rakesh Karanwal

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar