When to Go for Angiography of Coronary Arteries?
Stress test is a non-invasive, indirect method of knowing about the possibility of heart disease, especially the coronary arteries blockage.
Interpreting Stress Test
The abnormal stress test implies that there is a problem in cardiac functioning. Though one may not be able to know about the exact nature of heart problem solely from a stress test, but it does give some indication of coronary blockage as analyzed from stress EKG rhythm pattern. If the stress test is done along with a simultaneous thallium radioisotope scanning, then it may even show the specific areas of affected heart tissue. It’s true that you can’t directly visualize the coronary arteries during stress test, but it does give an indirect idea of their blockage.
Angiography of Coronary Arteries
The gold standard remains an angiography of coronary arteries. It’s a logical choice if there is an indirect evidence of coronary artery disease on stress test. Angiogram can visualize the exact place of blockage in the coronary arteries.
Angioplasty can be decided only after a blockage is confirmed on angiography. However, there remains a possibility that the blockage might not be seen on angiogram, but one needs to plan in advance for angioplasty. This helps in doing the angioplasty at the same session, rather than repeating the whole procedure.
Angiography remains the diagnostic test of choice, as you can directly visualize the blockage. MRI (or more precisely MRA) is still not considered as accurate as angiogram, though the complication rate is certainly much lower.
If there is a small blockage, one may be able to manage with medications like statins and aspirin. But the larger blockages commonly require angioplasty and stenting. Hence the extent of blockage should first be confirmed with angiography. Only after that, the cardiologist can decide whether to go for angioplasty, surgery or simply medications.
Hi, I am 36 years old with 69 Kg of weight. From last 5 years, I am having High Cholesterol and high blood pressure problem. In every test LDL is increasing and HDL getting low gradually. Last time I had done Lipid profile. Details are as below.
Sr. Cholesterol – 240
HDL – 30
Sr. Trigycerides – 351
LDL Cholesterol – 149
VLDL – 70.2
Cholesterol/HDL – 8.0
LDL/HDL – 5.0
Blood pressure – 110-150
Though sometimes I get very minor chest pain, but still my ECG shows everything is normal.
So should I go for Angiography to check the if coronary arteries are clogged and if yes then to what extent? Is Angiography is safe?
Thanks in advance.
You may go for a stress test. In this test, you are subjected to exercises and ECG is recorded while you exercise.
The test gives an indirect evidence about the status of coronary arteries. Only if TMT, stress test, comes out to be positive, angiography is required.
Hello Doctor,
As per your recommendation, I have done Stress test which was for 10 minutes. Following is the result.
Exercise tolerance: Average
Hemo Response: Hypertensive
Chrono Response: Normal
Final Impression: Hypertensive response, No significant ST-T changes during exercise, Negative TMT for the workload attained
Adv : Cardiac workup
Doctor advised me to do regular exercise and control on oily food.
Kindly suggest me from this result do we need to go through any other test?
Thanks in advance.
From these reports, you are not a cardiac patient. Angiography is not required.
However, you are a borderline case in the sense that, if you do not take precautions, you may go ahead towards being a cardiac patient.
You need to control three things, your overall weight, overall fat in your body and your blood pressure.
No medicines are required a the moment.
Monitor and chart your B.P. for a month, assuring that it reaches normal levels. Read here about reducing B.P. in a natural way.
I am 30 yrs old, male, some time i feel heaviness in my heart since 2 yrs, some time i feel good , some time i feel gastric problem which feels different, I have been checked by ECG , echo , all that normal …..so should I go for TMT or engiography. ……..my cholesterol report shows 165 (triglycerides )………….pls reply
Apart from feeling heaviness in the chest, any other symptom, like breathless on exercises, pain in chest, weakness etc.
Hello Doctor,
I am taking bp one tablet concor 2.5 per day from 2005, my cholestral was variying from optima and normal from 2005 now my choletral is normal.
Recently i feeled anexity and some burping and discomfort on my chest and getting sharp pain like second some times for 2 to 3 days then normal. then i went to doctor he took ecg and troponine test and echo and TMT all are normal.
Bur i feel discomfort on chest light pain, while checking BP 110/70 and some time 130/95 some time 125/85 like that.
I wooried some blockage on my valave, can i go for Angiogram.
And also i has GERD while endoscopy, dr. said have hital hernia.
Please advice.
If its related to your heart, you’re likely to feel breathless or tightness over the chest area after exercises.
I have left arm pain and jaw pain,no chest pain. my triglycerides is 146, hdl 40 and LDL 34. ECG, 2d echo and tmt test done. All are normal.still pain exists. Is it necessary to do angiography??
What was the exact report of your TMT test?
BP response : Normal
Arrithmia : None
H.R Response: Normal Chronotomic response
Final Impression: Negative for provocable myocardial ischemia
Angiography is usually not required in cases where TMT stress test gives a normal report.
Sir. I am having Hypertension since 5-6 years. I am taking medicine Lodoz 2.5. Also I am taking Clopitorva-10 tablet for high cholesterol. I m having frequent chest discomfort, antina type symptoms. But my ECG are normal. I hade kept my TMT test done in 2014, which was normal (Negative).. What U suggest for me?
Any breathlessness on exertion, like running, climbing stairs quickly etc.?
my echo, cholesterol sugar normal
bp slightly low
but Tmt positive at 4 METS
SHOUL I GO FOR CT ANGIO or its afalse positive
Kindly let us know your symptoms? Any breathlessness, pain in chest or elsewhere, weakness etc.?
ECG Ok
TMT NORMAL
ECHO TEST Normal
Conclusion after TMT. BORDERLINE TOE
SUGGESTING FOR ANGIOGRAPHY
What should I do
TMT SUMMARY
Resting ECG normal
FUNCTIONAL CAPICITY NORMAL
HR Response to exercise normal
BP response to exercise – normal resting BP-appropriate response
Chest Paine none
Arrhythmia none
ST changes none
Overall impression Nort
Conclusion by Dr. borderline toe
Echo test all normal
ECG OK
TMT SUMMARY
Resting ECG normal
FUNCTIONAL CAPICITY NORMAL
HR Response to exercise normal
BP response to exercise – normal resting BP-appropriate response
Chest Paine none
Arrhythmia none
ST changes none
Overall impression Nort
After TMT Conclusion by Dr. borderline toe
Echo test all normal
ECG OK
DR Suggesting Engiography. What should I do.
As you may understand, your reports are near normal. Your doctor wants to be exactly sure of your case and so, is suggesting angiography. However, it’s entirely your decision whether to go for it or not.
Even with normal reports, angiography may reveal some minor blockages which need to be taken care of. In most such cases, lifestyle and dietary precautions are enough to solve the problem.
I am 54 male, 90kg.I had heavyness in left hand. Which was treated successfully as because of spondylitis. In a routine checkup My TMT has been termed as borderline positive. I have been taking cilakar 10mg for the last 5yrs or so. Otherwise I had no other problem. Next day I got stress echo done in a different hospital which was negative. lThere the doctors told me not to worry at all. I am very much puzzled?
Difficult to comment without actual exam.
In general, TMT is more precise in assessing the heart status.