What Do The Following Test Reports Suggest?

Posted on Wed, 26 Aug 2015

Question: Hi Doc,
There have been a rise in Cardiac Arrest cases with people working with IT Industry.
Please help me with all the relevant tests, to be done to rule out blockage and heart related issues. I understand that Angiography is the de-facto standard, however, I do not want to go for it. I understand that there are other tests which can hint for a need of Angiography.
I am 33, wife 29, father 67, Sister 41 and Brother in law 47.
I want to get all the full heart checkup for my entire family. I have cut down my expenses to save for this.
Please help me with the detailed reply as XXXXXXX doctors do not explain in detailed manner. I also need to know why I need to go for a particular test and why I don’t need to for othersI. I hope you understand what I mean.
I have done some research on this online, however, will share my findings after your reply.
Looking forward to your response.
Regards,

Answered by Dr. Anantharamakrishnan (3 hours later)

Brief Answer:
Examination / followed by a sequene of tests

Detailed Answer:
Hi friend
Welcome to Health Care Magic

Information online is uncensored and one needs to be very careful I selecting quality site...

A thorough history and physical examination is the first step – consult a cardiologist
ECG (Electrocardiogram / EKG) – Routine 12-lead – is part of clinical examination.

     Basic blood tests – sugar, lipid profile, Homocysteine etc are done to assess modifiable risk factors
     HOLTER (24 to 48 hour ambulatory monitoring) is done to analyse irregular beats, if any
     ECHOcardiogram is necessary to see the heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality) / clots...

      TMT is done to evaluate ischemia (reduced blood flow / Coronary Artery Disease – which is the bad affliction in adults and I presume you are looking at it…
If TMT (Treadmill Exercise ECG) suggests ischemia, it is an indication for further work up. The next step is TMT 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) – CT angio is non-invasive study for the anatomy. If positive, one will need catheterisation, anyway way to directly ‘see’ the block, if any – and its location, extent, severity and so on.

Good luck
God bless you

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

Follow up: Dr. Anantharamakrishnan (22 hours later)

Hello Sir,

Thank you for the response. I have few more questions:-

1. Stress Echo or TMT? What is the difference? Which one is more effective in revealing the blockages?
2. Basic blood tests – sugar, lipid profile, Homocysteine etc . Please elaborate the tests name when you etc.
3. Please also advise how frequent one should repeat blood tests, EGC, Echo, TMT, etc?

Regards,

Answered by Dr. Anantharamakrishnan (1 hour later)

Brief Answer:
TMT / Lipoprotein analtsis / yeraly if abnormal

Detailed Answer:
Welcome to HCM

There is no significant difference in the outcome between the stress ECHO and Stress ECG (TMT) / Stress ECHO is operator dependent and may be difficult in some people, - example obese. TMT is easier to perform and interpret, and most labs and practioners can do. The choice often depends on the experience of the person doing it.

Other tests include lipoprotein analysis, fibrinogen, N terminal BNP, CRP, blood counts, Kidney function.

If the test results are normal, repeat it after 5 years if age is 30 or less / every 2 years after that / yearly after 40

Regards

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

Follow up: Dr. Anantharamakrishnan (20 hours later)

Thank you Sir. Few more questions:-

1. Can a gas pain cause pain in & around the heart area? If yes/no, how to rule that out that it is a gas or not a gas pain?

2. I have checked with Metro Hospital XXXXXXX They have a heart package with EGC and TMT along with Echo etc. Is EGC required, when we are going for TMT? (As you said that TMT is stress EGC)

3. The package include ECG, All Blood tests, ECHO, TMT, Chest X Ray & Lungs Function test. Is there anything to add to this?

Regards,

Answered by Dr. Anantharamakrishnan (2 hours later)

Brief Answer:
See below by qn #

Detailed Answer:
Hi

1.     Gas pain is layman’s term. It generally means muscle pain. It can be diagnosed by history and physical examination in most people / at times investigation to exclude other causes. If you mean gas in the stomach, it can be investigated by endoscopy

2.     Yes. Routine ECG IS A MUST, before TMT. TMT must be avoided or becomes uninterpretable with some findings in routine ECG..

3.     Yes. Several other things are there… but they will be dictated by the relevant findings on the previous routine test results…

Regards

Note: For further queries related to coronary artery disease and prevention, click here.

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