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How to determine blockages in coronary or other arteries when they have normal cholesterol numbers?

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General & Family Physician
Practicing since : 2005
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I am interested to know whether there is a routine method for determining whether a person could have blockages in coronary or other arteries when they have normal cholesterol numbers. I have normal cholesterol numbers but have had higher numbers in the past. I have done a stress test two years ago on a tread mill and an MRI (with injection) and EKG. Do these determine if a person has those blockages, and if not why don't doctors seek to routinely check for blockages in middle-aged men?
Posted Tue, 21 Aug 2012 in Hypertension and Heart Disease
Answered by Dr. Shanthi.E 50 minutes later

Thanks for posting your query.

Treadmill exercise stress test determines a person's susceptibility to develop a coronary heart disease in the future. It also gives a rough idea about the current status of the heart.

EKG gives an idea about the heart current status and also sometimes reflects old changes in the heart like an old myocardial infarction. An MRI can definitely show a block in the coronaries.

There is a routine method that can help in determining whether a person could have blockade in the coronaries. It is called the coronary angiogram. It is done in individuals at high risk of developing coronary heart disease and in persons with heart symptoms like chest pain.

Coronary angiogram tells all the details about coronary blood flow, the number of arteries blocked, the name of the artery that is blocked, the percentage of the arterial lumen that is blocked. It is done as a routine pre-operative work up in patients with coronary heart disease.

The investigation is not sought after routinely as it is not cost effective for the general population. Not all patients can afford to get a coronary angiogram done. It is an invasive procedure. There are operative risks involved with the procedure. Most importantly not all middle-aged men having chest pain have an underlying cardiac disease.

Current ATP (Adult Treatment Panel) 3 guidelines in US recommend fasting lipid screening in all adults >20 years of age, repeated every 5 years. It is not mandatory for all, though.

If in doubt, you may get a coronary angiogram done to look for the blockade.

I hope to have answered your query. Do write back for further discussion on this.

Above answer was peer-reviewed by
Follow-up: How to determine blockages in coronary or other arteries when they have normal cholesterol numbers? 24 minutes later
Thank you. This is very informative. So basically if a middle aged man shows no other physical or clinical symptoms there is no need to do the MRI or angiogram? That's good to know because it eliminates an element of worry even when a person has other concerns such as being overweight.
Answered by Dr. Shanthi.E 7 minutes later

Thanks for writing back.

Yes, you are right. There is no necessity do to investigations like MRI or angiogram in you.

However, please do repeat your fasting lipid profile every 6 months to be on the right track. This is important specially because you had previous high values, your age is 56 and you are on a diet for obesity. Apart from diet, include exercise in your routine.

You are doing well; continue to follow the good lifestyle.

If you have no more queries, you may close the discussion and write a review.

Thank you too.

Take care.
Above answer was peer-reviewed by
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