Is there anything to worry

[sidhu2005]

Hi,
I'm a 36 yrs old healthy (apparently) man working with power generating company. Recently I had go through a medical test as it was mandatory to buy a term insurance. The results of all the tests were normal except TMT.
Weight 65 KG, Height 175 cm, BMI:21.2, Blood Pressure: (130-115)/(95-80), not taking any medicine, Never experienced any pain or discomfort while exercising. Exercise moderately (can run 3.6 Km in 30 min).
Test Results:
CBC & ESR: Normocytic & NORMOCHROMIC Picture.

Biochemistry
S. Cholesterol: 160 mg/dl, S. Triglyceride: 95 mg/dl, H.D.L. Cholesterol:48 mg/dl, L.D.L. Cholesterol:93 mg/dl

SGOT: 28 IU/L, SGPT: 30 IU/L, GGTP: 16 IU/L
Total Proteins 7.6 mg/dl, S. Albumin 4.5 mg/dl, Globulin 3.1 mg/dl
Alkaline Phosphatase: 148 IU/L

Bilirubin: 0.6, direct 0.3, indirect 0.3 mg/dl
S. Creatinine:0.8 mg/dl
Blood Urea Nitrogen: 14 mg/dl
Fasting Blood Sugar: 70 mg/dl
HbA1c %: 4.8 %

ECG: LVH (borderline), rest OK

TMT Test:
ECG during baseline, standing and hyper ventilation showed no significant ST-T change.
There were significant ST/T changes seen in inferolateral leads during peak exercise and early recovery.
No S3, S4 crepts noticed during exercise
Final Impression:
• Normal chronotropic and BP response seen
• test is positive for inducible ischemia
• Good exercise tolerance noted


Note: My mother was having CAD and she was died due to the same at the age of 49.

Considering the above facts, please tell me whether I need to take any medicine and additional tests are to be performed.
Looking for your early response!

Regards,
Siddhartha

[brhill11]

Sorry Ed, I put in the wrong salutation, but was trying to reassure Sidu because all of my research says when ST segment depression occurs in the inferolateral leads during exercise in asymptomatic people, there is no evidence that it means anything.  His triglycerides are a little higher than desirable,  the cholesterol is fine. HDL could be better, but that is likely the hereditary component.  But overall, there is nothing disconcerting about those results.  While I would consult a cardiologist, I would be looking for some proof that this TMT  finding  has any validity before agreeing to anything invasive.  

[brhill11]

Hello Ed,
I"m not sure I agree with the previous response.  Read this article.
http://www.japi.org/march_2011/article_06.html. "All cases in the study group with positive TMT in inferolateral leads were asymptomatic healthy persons with no cardiac risk factors and were found to have positive TMT during medical examination" but apparently they looked at 152 people who had no symptoms and while they had irregularities in those particular leads, 100% had no ischemia. The author writes for disregarding positive findings in the Inferolateral leads --  Sounds like your case is very similar.  This is a classic false negative problem.  Do what you think is right, but I wouldn't worry too much about it if I were you.

[sidhu2005]

Thank you very much for your reply.
Here I'd like to share certain facts: Inever smoke or drink in my entire life, very occationally take junk food, always try to control fat & extra salt in diet. exrcise moderately- can run 4KM within 30 minutes without any major discomfor or chest pain, BMI is always maintaint below 22, BP is tried to maintain at normal level without taking any medicine, although sometimes diastolic pressure goes up to 95 mmhg whereas systolic pressure remains normal.
Is there really any problem with my heart? can the TMT result false positive. Should I consult another cardiologist and get another TMT/ Echo done? I really worried "as it runs in the family".
Regards,
Siddhartha

[ed34]

It looks as though you are developing artery disease. I would certainly make some serious lifestyle changes, lowering fat and sugar intake. I hope someone else will look at your cholesterol levels, in the uk we use a more accurate measurement of mmol/L. With regards to medications, I would leave that to a Doctor to decide. They may want to start you on a statin to reduce artery inflammation and get the cholesterol even lower. They may also want to introduce daily aspirin to lower the risk of stroke/heart attack, but any medicine is down to the decision of a Doctor. Now is obviously the time to act on changing bad habits if you have any, especially as it runs in the family.