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Had Health Check Up. What To Do If Tested Positive For Inducible Ischemia?

Posted on Fri, 13 Dec 2013

Question: Dear doctor, my father 65 years age undergone executive health check up in a corporate hospital, BIOCHEMISTRY REPORT : CHOLESTEROL-SERUM/PLASMA -211, HDL CHOLESTEROL - SERUM / PLASMA - 50, TOTAL CHOLESTEROL / HDL CHOLESTEROL RATIO - 4.2, TRIGLYCERIDES - SERUM - 146, LDL CHOLESTEROL - SERUM / PLASMA - 132, TMT Test Report - The patient exercised according to the XXXXXXX for 5.04 mins, achieving a work level of XXXXXXX METS: 7.00 resting heart rate of 61 bpm XXXXXXX to a maximal heart rate of 142 bpm. The value represented 91% of the maximal, age-predicted heart rate. The resting blood pressure of 120/80 mm Hg, XXXXXXX to a maximum blood pressure of 200/90 mmHg. The exercise test was stopped due to Fatigue / SOB. CONCLUSIONS: 1) SYSTOLIC HIGH BP RESPONSE 2) NO CHEST PAIN / ARRHYTHMIA 3) AVERAGE EFFORT TOLERANCE 4)TEST IS POSITIVE FOR INDUCIBLE ISCHAEMIA. Based on the above reports 1) What do it mean, test is positive for inducible ischaemia 2) What should be my next step ? Regards, XXXXXXX

Answered by Dr. Anantharamakrishnan (52 minutes later)

Brief Answer: Needs follow up / more tests Detailed Answer: Hi friend, Welcome to Health Care Magic CHOLESTEROL There are subdivisions of cholesterol – LDL, HDL, non-HDL and so on. LDL (& non-HDL) is bad cholesterol – lower, the better. HDL is good cholesterol – higher, the better. In the absence of any other risk factor 100 is ideal for LDL-C. In the presence of ischemia, 70 should be the aim. Keep weight normal / even a little less Quit smoking, if he is a smoker Regular EXERCISE – say walking or jogging - 30 minutes a day / at least 5 days in a week. Healthy FOOD is a must. Avoid saturated fats – coconut oil, palm oil, butter, ghee, full cream milk...Avoid junk foods in particular – French fries have palm oil / Pizza has cheese / Indian sweets are made in ghee.../ Change to Poly-un-saturated oil – like sun flower oil. / Include Mono-un-saturated oil – Olive oil. Repeat the test in 6 weeks. Cholesterol can still be high, in spite of diet and exercise – you need drugs; Because it is also manufactured in the liver – and that is determined by heredity. Statin is the first choice. Some start it straight away – even with normal levels, even without problems (Primary Prophylaxis) SUGAR Value after food is borderline Do GTT and HbA1C ECG He needs to be investigated for Coronary Artery Disease. When TMT (Treadmill Exercise ECG) suggests ischemia, it is an indication for further work up – because at times, there may be false positive or false negatives. The next step is TMT with thallium isotope. It is the ideal non-invasive way to evaluate ischemia / to assess the PHYSIOLOGY (function) – to see whether the blood arriving at the heart muscle. If there is a suggestion, the next step is to see the ANATOMY (structure) – undergo catheterisation and coronary angiography with a view for possible intervention. It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on. Coronary arteriography is invasive but it is the gold standard for this. [CT angio is non-invasive study for the anatomy. If positive, he will need catheterisation, anyway.] The aim of any investigation is to modify the treatment, based on the result. Intervention – dilatation with balloon and placing a stent (Angioplasty) - or CABG (Coronary Artery Bypass Graft) may be advised based on the results. The treating doctor alone can suggest further based on his assessment of the situation. Good luck Take care Wishing all well God bless

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (4 hours later)

Thanks doctor for your valuable suggestions and advise, sending TMT report and final impression given by doctor. 1) It will be helpful ,if you can explain TMT report , in which page, where we can see TMT IS POSITIVE INDUCIBLE ISCHEMIA 2) If you were in that place, what would be your final impression report. 3) What would you have suggested to patient , in written. Regards, XXXXXXX

Answered by Dr. Anantharamakrishnan (22 minutes later)

Brief Answer: Repeat and correlate clinically Detailed Answer: Hi Suggestive changes in ECG # 2 / clear in ECG # 3 / prominent from # 6 onwards I would have suggested to repeat – thallium stress ECG Any investigation must be correlated with the clinical status Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar