Brief Answer:
please see details below

Detailed Answer:
Dear Sir
1. The discharge summary, ECG and ECHO report suggests that this patient was having pain chest for 3 days prior to presentation on 13-08-2016. The ECG has some dynamic changes. ECHO shows abnormality. All these together suggest that patient had possibly acute heart attack in those three days. It would have been more confirmatory if blood test pertaining to heart attack were available (like troponins).
2. The question "MUST" or Unavoidable" regarding most of medical procedure is not valid in itself. A medical procedure may be recommended or useful in a given clinical situation but ultimately patient's wish is supreme. No procedure can be forcefully done on anyone. Simple explanation is that a given procedure is not useful for 100% of patients. Coronary angiography in a case of acute heart attack is recommended if patient presents within 12 hours of onset of chest pain. It is also recommended if patient presents late but has ongoing chest pain. These recommendations are standard of care. Currently if patient has symptoms suggestive of angina or angina equivalent (like breathlessness) the angiography may be done. It depends upon the clinical assessment of cardiologist, report of fresh echo etc. Patient may be subjected to stress test (if the clinician thinks so) and decision may be taken about angiography thereafter.
3. Weakness, back pain, muscular pain are symptoms which may be related to use of drug named TONACT. It can be managed in multiple ways including decreasing the dose, changing the medicine, changing the brand etc. It will be best decided by your physician. Ecosprin and tonact like drugs are given life long in majority of patients. Axcer like drugs are given for 9-12 months. Telma may also be required for whole life.
Feel free to discuss further.
Sincerely
Sukhvinder

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Brief Answer:
please see detailed reply

Detailed Answer:
Dear Sir

1. No, this information (result of troponin assay) was not available in the two separate reports you uploaded. No, It is not recommended so late after the index event.

2. In the given case scenario, where probability of having a disease is high, CT angiogram does not have a role. Because once the CT angiogram shows disease (whose pre-test probability is high) conventional angiogram has to be done to confirm the findings. Indications of angiogram in current scenario has already been discussed in previous answer.

Sincerely
Sukhvinder

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