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Postmenopausal bleeding, no angina or breathlessness. Is coronary angiogram needed?

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Practicing since : 1981
Answered : 922 Questions
Respected sir,
My mother aged 55yrs, height 164cm,weight 74kg,
no past history of diabetes, hypertension,hypercholestrolemia,CAD;
presented with postmenopausal bleeding fibroid planning for hysterectomy by epidural anaesthesia,In gynaec opd was detected to have BP of 140/100 on two occasions and was advised medicine consultation, but in medicine opd was detected to be 130/80.Later during pre anaesthetic check up BP was150/100 and was advised to have cardiac fitness before surgery.IN CARDIOLOGY opd BP was 140/100 (FBS94 PPBS122 TOTAL CHOLESTROL 235 LDL167 HDL46 TG 108 VLDL 22,ECG NL), advised echo and treadmill test and .ECHO normal,
TMT----- showed average effort tolerance.pseudonormalisation in LIII,V3 during the test.downsloping ST depression in LII,LIII,AVF,V4 to V6 from 3min recovery, persisted for more than 6 min.
total exertion time 6:2min
XXXXXXX bp 170/110 mm Hg
METS 8.00
distance covered 0.34km double product 0000.00 TMT terminated because of knee pain.
The cardiologist advised for coronary angiogram.
Sir now my queries are:
(1) Is CAG required as she is asymptomatic -no angina,breathlessness (even on TMT ,as it was stopped due to knee pain) .I do believe that best interventional cardiologist is the one who do minimum and most necessary interventions only. Why cause unnecessary complications out of it.
(2) sir i has just completed my mbbs, and i am the only doctor in my family,, and my relatives, friends, parents are of the opinion that the private hospital we went had only few patients and they are trying to do unnecessary investigations out of every patients for monetary benifits .
(3) should i repeat tmt ??
please give your valuable opinion.
thanking you
Posted Tue, 11 Sep 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 10 hours later
Thanks for writing in.
I am a qualified and certified cardiologist and I read your mail with diligence.

She did not perform complete exercise on TMT which you say because of knee pain. She might have coronary artery disease responsible for it. No point in repeating TMT. This is first time I am hearing the word PSEUDO NORMALIZATION in
relation to TMT where did you pick this word? She has some changes if coronary angiography reveals normal coronaries then only we can call test as false positive test. At present it is possible coronary artery disease test.

Coronary Angiography is practically without complications (1 in 0000 patients)
With best wishes.

You can take second opinion from one of the Government Medical Colleges there are plenty of these in your state. It may mean travelling for few hundred kilometers but that is OK. If you are a doctor you ought not be afraid of getting coronary angiography. Best of Luck.

With best wishes.
Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
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