Angio needed or not?

[Arumugam]

On a routine TMT I was positive for induced eschimia and asked to consult cardiologist. He advised angiogram. But I did not have any symptom like chest pain or short breadth. I went for cartography and found no problems. Should I undergo angiogram? pls advice.

[calcium539]

I would go for the 2nd opinion. My calcium score total was 262. My stress echo was abnormal. I did NOT have any symptoms. I am fit and healthy. I am a diabetic but my sugar levels and lipids are very well controlled. My cardio requested an Angiogram. I did but they did not do anything to me. I was told that there was an occulsion in obtuse marginal and the rest was in good shape. I was told to live a healthy life and take a baby Asprin a day. My cardio told me that DIABETICS sometimes do not have symptoms and insisted that I go for this Angiogram.

[Arumugam]

Thank you friends. I had an angio and the doctor told it is normal. How should I continue?

[calcium539]

I heard that DIABETICS dont feel symptoms of angina. Is this true?

[kenkeith]

When and if there is a silent heart attack, it almost always due to ischemia (lack of blood flow) over a period of time and more prevalent with the older generation (>70) and diabetics.
If you have regular physical exams, you shouldn't be concerned.

Indivduals and doctors' advice shouldn't and isn't be based on an expectation of silent heart attack. If you have a family history, etc. of heart problems, you should have periodic exams.  

I believe the inversion on an EKG relates to the "T" segment. An inversion on EKG Inverted T-waves can often be a normal variant in adults without cardiac symptoms, depending on the location of the inversion and if there are other abnormalities present. An EKG output is not sufficient to make a diagnoses, it requires other signs and symptoms to validate. Also, it can be an innocent variant, and if it is the "inferior" leads it is of little importance. Now at your age and with marginal lifestyle the most common reason for inverted T in ECG is "non specific" meaning that it does not relate to any specific disease condition and is just there.

You have established a baseline with your recent test, and your subsequent test can be revealing of any heart problems.  You are not on any great risk for a silent heart attack based on the information you have provided so you can relax.  

Hope this helps put you at ease and not worry.  Take care.

[Arumugam]

Thank you friends for educating me. I had a full 10 minutes TMT. there was no abnormalities. Only there were some inversions in one graph. So suggested for angiogram.
I was advised to go for cartography, which revealed no major problems.
I guess it does not indicate the block.
I had a echo cardiogram which also showed normal.
My scare is if I go for an angiogram will it cause itself any complications as Ken Keith points out.
But I am also scared of silet heart attacks without any chest pain symptoms.

[kenkeith]

I would get a second opinion.  There is generat agreement that occlusions don't require any intervention unless there are symptoms.  If you go ahead with a cath angiogram be prepared to be stented.  There are doctors that rationalize that after the intervention process they might just as well stent even if the blockage is less than the recommended by AHA/AAC of do not stent implant less than 70% blockage, if blockage is more than 70% treat with medication if there is angina (chest pain, etc.).  Stent, if medication doesn't relieve chest pain, etc.  If stent can be inplanted due location, size, etc. then a bypass.

You can research the subject further by reading results of independent studies such as COURAGE study, etc.  No one can advise you on any forum, etc. because there is incomplete health information, individual risks and circumstances that vary among individuals.  You should do your own research so you ask the correct question and have a good understanding what is involved.  I can tell you I have a totally blocked artery (over the years it has developed a natural bypass...no problem) and another that is 70% blocked for more than 7 years without any problems.  I take a med prior to any heavy duty exertion such as a workout at the gym...no problem.

A stent can collapse, migrate out of position, block again, form a clot that can cause a heart attack, etc.  The risk of the intervention is not without risk, but not likely.  Could rupture the vessel, cause an infection, cause a painful and dangerous clot, etc. There is no pain, and the patient is completely relaxed with medication.

Was the TMT terminated after reaching your heart target rate? No chest pain or SoB?

Thanks for your question, and if you have any followup questions you are welcome to respond.  Take care.

[ChatterAlly]

I would. There are heart attacks that happen without any symptoms.  Known as silent heart attack.  

[ed34]

Sounds like a good idea to do an accurate assessment. An angiogram will enable them to actually see the condition of your coronary arteries. Don't be too concerned that you had no symptoms, not everyone does. Some people actually develop collateral vessels, but the fact your test showed induced ischemia makes me doubt whether you have, or maybe not sufficient numbers of them.