Stress test results that warrant an agiogram

I am a 32 year old woman.  I have had mild, occasional chest pain the last several years.  I also feel frequent, mild pains in my arms and wrists.  I have no shortness of breath.  The pain occurs during moments of stress and not when I'm physically active.  I have a cholesterol score of 168.

I took a stress test last week.  Everything looked good except a shadow along the walls of my septum.  They said this could be a breast shadow or a blockage and I should have an angiogram.

My question is...Should I receive a second opinion...or is there only one way to read a stress test result?  Does an angiogram seem like a drastic measure for someone of my age with my symptoms?

Thank you.

[Darcy Green Conaway, MD]

hi Sue-
This is actuallya fairly common issue with stress testing in women; the pretest likelihood of a female your age having coronary disease is very, very low assuming the chest pain you are describing now is the chest pain you were experiencing then. Personally, I always try to balance the risk and benefit of a procedure; the standard of care is if you have a concerning stress test (showing coronary disease but not a high risk scan) and undergo aggressive risk factor modification (watch your weight, blood pressure, cholesterol) after the scan but continue to have chest pain a cath is reasonable. Having said all that, I tend to be very careful recommending a cath to someone with such low pretest likelihood of disease--if you think a second opinion is reasonable, I would go with that thought (primarily because I just think that a second opinion is never a bad idea unless you are postponing an urgent situation). If you go with that option, make sure you get copies of the stress test (not just the report) to hand carry with you