Next test after abnormal stress-echo?

[skippy_d]

I had a stress echo that showed abnormal results in the apical wall after exercising (to 98% of MHR for a 52 year old).  According to the cardiologist's nurse, the EKG was also abnormal after exercising and the doctor wants to do a catheterization.  Is it normal to go to such an invasive test as the next test after an abnormal stress echo or are there other tests that can be done?  I have an appointment to see the cardiologist scheduled to discuss the results and options but would like to have a little more information before the appointment.
Thank you.

[vicky1950]

You inquired about questions to ask before a cath. I was wondering if doctors request a troponin level to assist in detecting heart disease?   My father had a mild heart attack during surgury and his troponin level was taken at certain intervals after the surgery.
Does any one know what a high level of 4.97 troponin may indicate out there?
Vicky

[LukeL]

Remember that every test carries a risk and a doctor will usually only order a test if the  risks outweigh the real or potential benefits. In this case you are look at roughly a 1% chance for complications versus the chance of having hidden heart disease.  

To give you a personal story, I just had a benign tumor removed from my left ear and the doctor wants to go back in and take out more diseassed tissue because of a very small risk of it turning into cancer at some latter point. The risk of the surgery is virtually 0 and the risk of cancer is probably around 1% or less. So it would make sense for me to have the procedure.

[CCF-M.D.-PPB]

Left heart catheterization would be the next step after a positive stress test especially if you have exertional angina (chest pain or shortness of breath).  There are some new tests out there such as cardiac CT which can identify coronay anatomy and look for evidence of obstruction but there are some limitations to them, and most patients that end up getting them still go on to have cardiac catheterization.  Even though it sounds like a very invasive procedure, left heart catheterization is very simple and very safe with complication rates less than 1%.