Brief Answer:
Perfusion scan, and a iodine free XXXXXXX for angiogram if needed

Detailed Answer:
Hello sir, I am Dr. Mody and I would be addressing your concern.
Some basic information is your father diabetic, hypertensive, obese, a smoker and is he on any medication.
Secondly what where his symptoms, breathlessness, chest pain or you just visited the doctor for low pulse rate.
Also I would be happy if you can upload the ekg
Now coming to the future action
1)The tmt report you suggested is considered positive if traditional risk factors are positive, than directly an angiogram is suggested. However when you go for the same, you do tell your doctor about the allergic part, as now there are non iodine containing XXXXXXX which doesn't have the same risk as previously, so he can safely go ahead with angiogram.
2)now if he is symptom free and no traditional risk factors, I would strongly recommend you to go ahead with what is perfusion scan (thallium perfusion scan), if that is normal than no need for angiography. And if it has any perfusion defext we should for sure go for one as to prevent future risk.
Again in case senerio 1, we can get a perfusion scan, as many a times if angiogram shows 70-80 lesion, but there is normal perfusion, such cases should be managed medically and angioplasty will do no benefit.
Hoping I could help, any further information I would be happy to assist.
Dr. Priyank Mody, Lilavati Hospital, XXXXXXX

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Brief Answer:
Echo lipids good, tmt it's interpretation so can't comment on same

Detailed Answer:
Hello I did go through the reports,
Lipids are perfectly ok n rather I would say desirable values for all of us :)
2d echo is normal too, however I would like to point out that it would change only after a silent attack, so the correlation of the blocks in heart with abnormal echo is not as good as TMT, the simple reason it was done at rest
Pft is showing some evidence of asthmatic lung disease, the reason for his wheezing.
Now the wheezing itself can cause false positive stress test, it means that the test came positive, though there is no underlying heart disease, also considering his age he may have Co existing heart disease, so how do we know it.
1) if it was my patient and facilities were available I would proceed with a thallium perfusion scan and if normal nothing needed and if any problem here than only proceed with angiogram. Also the benefit here is when we know there is a perfusion defect we can proceed with the angiogram and if block is present treat it at the same go because we know objectively that it is significant to cause decreased perfusion. .
However if you and your doctor decides to go with angiogram, I would like to reassurance you that it would be safe in context of his wheezing and according to reports and clarification by you even routine XXXXXXX would be ok under proper care.
Also I would think that it's a typo error where instead of his respiratory rate, the heart rate would be 61, which is normal at his age.

Hopefully I could address your concern.
You may always axcess me through HCM. Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273
Regards Dr Priyank Mody, XXXXXXX
You may rate the conversation for other pts help :)

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