Nuclear stress test vs angiogram

I have beening experiencing episodes of chest pain/pressure, SOB and palpatations for several years.  I also can't stand up quickly, everything goes black and I feel like I'm going to pass out, but I never do.  I am a 44 year old female post menopausal (surgical), physically fit and at rest my BP is usually about 110/60 with a pulse rate of 52.  When this first started I had seen a cardiologist and had a bunch of tests.  I had an echo, EKG, Halter monitor and took a treadmill stress test.  Although all of these were "fine" I continued to have these symptoms.  Then my brother suddenly died at the age of 47 due to ASHD (diagnosed post mortem) and he was found to have many clots blocking 3 of his cardiac vessels.  I went back to the cardiologist for more tests.  My EKG and echo were WNL.  I had a Thallium stress test this time which revealed an apparent blockage of my LAD.  Followed up with an angiogram which showed a "sluggish emptying" of my LAD but not enough for any concern.  The invasive cardiologist recommended (my general cardiologist disagreed) I take a baby aspirin daily, which I do, but still have these symptoms.  I read somewhere that, for women, the nuclear stress test is more accurate than the angiogram.  Should I get re-evaluated?  

[Darcy Green Conaway, MD]

The angiogram is the "gold standard", meaning that it shows you real anatomy. The stress test looks at perfusion (blood flow) to an area so that when it is abnormal it implies blockages in certain blood vessels may be there. In women the nuclear (thallium) stress test often is false positive due to breast tissue and this is the same territory as the LAD. To me, 'sluggish emptying' doesn't mean much as you either have a blockages or you don't. I don't think your passing out problems are due to this, but you could consider getting a coronary CTA to look at the coronary anatomy and just make sure there are no concerning anomalies.

[fbyf]

I'm a 52 year old woman, suffering with exercise induced chest pain.  Asthma has been ruled out.  My medications include Sinemet, Mirapex, Azilect and Synthroid.  I also took Provigil about a year.  A stress test is next, however if angiography is the better indicator, shouldn't I push to skip the time and expense of the stress test and go straight to the angiogram?  

Why isn't angiography the first step typically, since the stress test does not have as acurate results?  

Thank you, Meredith

[Eileen1948]

A related discussion, different tests was started.

[Guppoodad]

A related discussion, Stress test vs CAT angiogram was started.