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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Chest Pain, Shoulder Pain, Anxiety Neurosis, Prescribed PEXEP CR, Had Angiogram And Stress Thallium Test Negative, TMT Test Positive. Heart Problem?

I have undergone twice Angiogram and Stress Thallium both the results are negative and says insignificant angina, however my TMT test is always positive. These test are done about two years back, from last one month I am feeling mild chest pain followed by shoulder pain during walking and later disappears. Diagnosis by Doctor suggest that I am suffering from Anxiety neurosis and prescribed PEXEP CR 12.5MG. I would like to get second opinion from you. and confirm it is not heart problem and only anxiety. Opinion in this regard appreciated. Thanking you . Raju
Fri, 1 Jun 2012
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Cardiologist,  's  Response
hi and welcome mr raju. i dont exactly your age and risk factors for heart diseases like high blood pressure or diabetes, over weight , smoking etc. but the symptoms you said are strongly suggestive of heart disease ( ANGINA). well if you have risk factors and your age is more than 50 , the probability is high for heart diseases. another explaination is that your chest heaviness and its associated symptoms are produced by exercise and disappears with rest . this is typical of angina. also you mentioned that your TMT tread mill test ( EXERCISE TEST) HAS BEEN POSITIVE FOR ANGINA, thallium scan and angiogram done 2 years back is long time . if its clear then with the symptoms still persists , it can be blood vessel occlusion/ blockage at the micro levels which normal angiogram can not pick because angiogram sees only major vessels . thallium stress did show mild ischemia/angina. i would suggest that its been 2 years now. before going for any expensive and invasive tests you better go for dobutamine stress echocardiogram. if there is wall motion abnormality during chest pain , ischemia and angina are probable..... now to look for if that is on macro or micro level repeat diagnostic angiography . i also dont know whether you have ever been given nitrates which reduces the pain after you put it under your tongue. i would suggest that you take appointment from a senior cardiologist who will look into your matter and proper advice. take care and good luck . if u have any query , dont hesitate to ask . best regards
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Chest Pain, Shoulder Pain, Anxiety Neurosis, Prescribed PEXEP CR, Had Angiogram And Stress Thallium Test Negative, TMT Test Positive. Heart Problem?

hi and welcome mr raju. i dont exactly your age and risk factors for heart diseases like high blood pressure or diabetes, over weight , smoking etc. but the symptoms you said are strongly suggestive of heart disease ( ANGINA). well if you have risk factors and your age is more than 50 , the probability is high for heart diseases. another explaination is that your chest heaviness and its associated symptoms are produced by exercise and disappears with rest . this is typical of angina. also you mentioned that your TMT tread mill test ( EXERCISE TEST) HAS BEEN POSITIVE FOR ANGINA, thallium scan and angiogram done 2 years back is long time . if its clear then with the symptoms still persists , it can be blood vessel occlusion/ blockage at the micro levels which normal angiogram can not pick because angiogram sees only major vessels . thallium stress did show mild ischemia/angina. i would suggest that its been 2 years now. before going for any expensive and invasive tests you better go for dobutamine stress echocardiogram. if there is wall motion abnormality during chest pain , ischemia and angina are probable..... now to look for if that is on macro or micro level repeat diagnostic angiography . i also dont know whether you have ever been given nitrates which reduces the pain after you put it under your tongue. i would suggest that you take appointment from a senior cardiologist who will look into your matter and proper advice. take care and good luck . if u have any query , dont hesitate to ask . best regards