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Reports Show Positive For Inducible Ischaemia. What Does This Mean? What Should Be The Next Step?

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. Pratap VGM (1 hour later)

Brief Answer: Suspected blockage in coronary arteries Detailed Answer: Dear Query reviewed, blood investigations appearing normal. Treadmill test positive for inducible ischemia with high systolic blood pressure, let me explain to you. In normal resting state circulation to heart will be normal due to low oxygen demand, which means less circulation. Heart muscles are supplied by coronary arteries but when even there is more exercise and physical activity there is increased demand of oxygen by heart muscles, so there will be increased circulation.. If there is blockage in the coronary artery circulation then during resting state there will be normal blood flow. But whenever there is increased load there will be decreased blood flow to the cardiac muscles. It will be reflected as inducible ischemia. The followin steps are very important 1. Strictly control your blood pressure, try to add a beta blocker group of drug after consulting your doctor 2. Advised to do coronary artery angiogram to know the position and degree of blockage. 3. Antiplatelet therapy consideration after reviewing with your doctor Proceed with the tests without hesitation Thanks

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Pratap VGM (3 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. Pratap VGM (1 hour later)

Brief Answer: Antiplatelet and dual antihypertensive drug therap Detailed Answer: Dear XXXXXXX I reviewed your query The main problem is high blood pressure.. he is been advised to take repace 50 mg, but I don’t think it would be enough.. You need to add one more drug for better control.. Consult your doctor and ask him about starting betablocker ideally metaprolol, which has beneficial effects on heart. Secondly its recommended for your father to start antiplatelet therapy, like clopidegril and aspirin.. so speak to your doctor once.. Corronary angiogram is usually recommended but it is left to the discretion of treating doctor, consulting cardiologist and patient affordability to undergo the test, but its recommended.. Patient has little high post prandial sugars, recommended to do glycated hemoglobin testing once. Thanks

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Above answer was peer-reviewed by : Dr. Shanthi.E