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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Chest Pain, Shortness Of Breath, Stress Test Shows Borderline Positive For Inducible Ischemia. Treatment ?

I am a 60 year old female in good general health; Have been exercising regularly, cardio and strength; Weight = 144; 65 " tall; Have been having chest pain and shortness of breath past couple of months; Stress test showed 1.5 mm up-sloping ST segment depression seen in inferior and lateral leads during peak exercise, normalized rapidly during recovery; Stress test was borderline positive for inducible ischemia (consider further studies); Echo showed Stage 1 diastolic dysfunction consistent with mildly impaired LV relaxation. Is this something to be concerned about?
Tue, 17 Sep 2013
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Cardiologist 's  Response
Hi friend,
Welcome to Health Care Magic

You need to be investigated for Coronary Artery Disease.
     It is an indication for further work up – because at times, there may be false positive or false negatives. The next step is TMT (Treadmill Exercise ECG) with thallium isotope. It is the ideal non-invasive way to evaluate ischemia / to assess the PHYSIOLOGY (function) – to see whether the blood arriving at the heart muscle.
     If there is a suggestion, the next step is to see the ANATOMY (structure) – undergo catheterisation and coronary angiography with a view for possible intervention. It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on. Coronary arteriography is invasive but it is the gold standard for this. CT angio is non-invasive study for the anatomy. If positive, she will need catheterisation, anyway.

The aim of any investigation is to modify the treatment, based on the result.
Intervention – dilatation with balloon and placing a stent (Angioplasty) - or CABG (Coronary Artery Bypass Graft) may be advised based on the results.

Take care     
Wishing all well
God bless
Good luck
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Chest Pain, Shortness Of Breath, Stress Test Shows Borderline Positive For Inducible Ischemia. Treatment ?

Hi friend, Welcome to Health Care Magic You need to be investigated for Coronary Artery Disease. It is an indication for further work up – because at times, there may be false positive or false negatives. The next step is TMT (Treadmill Exercise ECG) with thallium isotope. It is the ideal non-invasive way to evaluate ischemia / to assess the PHYSIOLOGY (function) – to see whether the blood arriving at the heart muscle. If there is a suggestion, the next step is to see the ANATOMY (structure) – undergo catheterisation and coronary angiography with a view for possible intervention. It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on. Coronary arteriography is invasive but it is the gold standard for this. CT angio is non-invasive study for the anatomy. If positive, she will need catheterisation, anyway. The aim of any investigation is to modify the treatment, based on the result. Intervention – dilatation with balloon and placing a stent (Angioplasty) - or CABG (Coronary Artery Bypass Graft) may be advised based on the results. Take care Wishing all well God bless Good luck