nuclear stress test results and what to do next

[bham_bob]

I'm 30/male, 5'10 240 lbs. I went to a cardiologist with:
New onset palpitations
atypical chest pain (heavy, tight, not worse with exercise)
feeling breathless
New onset exercise intolerance/fatigue
over-awareness of heartbeat (beating too strong)
Near constant lightheadedness

I'm about to have a CTA done (actually he gave me the option between CTA and cath. He said if I was 50 he'd say cath but due to my age he said CTA should be okay).
IF that is normal, then does that mean the stress test was a false positive?
How often do you see stress tests like this turn out to be "nothing"?

(I should point out that at home I'm able to exercise 30 mins daily at a HR of 155-160, it's just the intensity level of the treadmill was too high for me; but I still do perceive far more fatigue than usual)

Max HR: 184
Exercise time:  7:30
Reason to terminate: fatigue
Left ventricle size/thickness normal. EF 61%
Perfusion: Abnormal
Ischemia: Mid anterior

FINDINGS:
1. Reduced nuclear isotope uptake in the mid anterior wall on stress imaging when compared with rest imaging. Findings may indicate ischemia in the distribution of the left anterior descending or branch vessel of the left anterior descending.
2. Soft tissue attenuation does reduce the sensitivity and specificity of the study.
3. Mild hypokinesis of the mid anterior wall with otherwise normal segmental wall motion and a calculated ejection fraction of 61%.
4. Normal left ventricular size and wall thickness.
5. Clinically negative and electrically nondiagnostic stress, exercising only 65%.

CONCLUSION:
1. Nuclear imaging suggests the possibility of ischemia in the distribution of the left anterior descending. Very poor exercise tolerance, as well. Clinical correlation recommended.

THANK YOU FOR YOUR TIME

[Cleveland Clinic]

I would think not, and this is not one that you want to miss. The CTA is a good test especially in young people with non calcified vessels, but is is not 100% sensitive. A left heart cath will leave no doubts about the results, and the benefit is that they can perform an intervention at the time of the procedure. If you miss a lesion in your LAD, especially with your symptoms and poor exercise capacity, you may later on develop worsening heart failure or a heart attack. I would recommend proceeding with a left heart cath over the CTA for this reason.

[bham_bob]

Bottom line, i guess the main thing i'm wondering is..if CTA is normal then can I move on and forget about this?  Would a normal CTA "over ride" this "abnormal" stress test?

[bham_bob]

Doc thanks for the reply,   when you said "you may later on develop worsening heart failure", did you mean to imply it sounds like i already have some form of heart failure?

So, if i have the CTA and it's normal,   I would still want to get a cath, if i've already done the CTA?