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Is It Necessary To Take Angiography For Stress Induced Ischemia?

Posted on Thu, 26 Dec 2013

Question: my friend has been diagnosed in stress thiallum test ...stress induced ischemia mid septal infero,,,lvef 65,,, lipid profile very normal ,bp under control ,,, is there a need for angio??? he had no symtoms other than swelling in feet after exercise ,,,he is 59

Answered by Dr. Anantharamakrishnan (17 minutes later)

Brief Answer: Yes / definitely needed Detailed Answer: Hi friend, Welcome to Health Care Magic Yes, he needs angio, for sure Angio is an investigation; The aim of any investigation is to modify the treatment, based on the result. Absence of symptoms is no proof of absence of disease. In a quarter of patients, the first manifestation is sudden death / in another quarter, heart attack is the presenting symptom Your friend needs to be investigated further for Coronary Artery Disease. TMT (Treadmill Exercise ECG) with thallium isotope is the ideal non-invasive way to evaluate ischemia / to assess the PHYSIOLOGY (function) – to see whether the blood arriving at the heart muscle. And your friend has a problem here 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. He must have angio / that too as early as possible Good luck Take care Wishing all well God bless

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

Follow up: Dr. Anantharamakrishnan (1 hour later)

but he has good lvef??and only reversible ischemia of stress induced ,,what is mid septal infero septal?? Moderate stress induced ischemia in mid septal infero septal. Good systolic LV function Emory cardiac tool box shows no evidence of reversible ischemia in entire LV myocardium LVEF stress. 65 percent This all written in report

Answered by Dr. Anantharamakrishnan (4 hours later)

Brief Answer: Go for angio Detailed Answer: Hi Emory Toolbox is a software program for computer analysis. The interpretation has to be reviewed by the treating physician and correlated with total clinical picture – it is to supplement not supplant clinical impression LvEF is one parameter of function / the global function is well / there could still be focal problems Septum is the portion (partition between right and left) of the ventricle (lower chambers). Inferior wall is the lower wall of the ventricle. This is usually supplied by LAD (left Anterior Descending) artery Reversible indicates that the area is in jeopardy, but not damaged yet. It is not able to get its blood supply during stress (increased demand); and the flow resumes when the stress is off and is sufficient at rest… Angio is the gold standard, against which all other investigations are compared. It is like seeing the substance and the shadow. It is just an investigation to help in better decision making. It is better to be safe than sorry - treated if a problem is found / Happy, if it turns out otherwise Regards

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

Follow up: Dr. Anantharamakrishnan (2 hours later)

Thanx a ton doctor ,, so thAt means my friend has a disease which can be treated but should be treated immedietly

Answered by Dr. Anantharamakrishnan (12 minutes later)

Brief Answer: Yes Detailed Answer: Hi True There is an extremely high probability It should be managed so, until and unless proved otherwise Good luck

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