Hi friend
Welcome to Health Care Magic

CHOLESTEROL
There are subdivisions of cholesterol – LDL, HDL, non-HDL and so on.
LDL (& non-HDL) is bad cholesterol – lower, the better.
HDL is good cholesterol – higher, the better.
The value of 131 is just high for LDL cholesterol. In the absence of any other risk factor 100 is ideal. [130 was allowed before.] In the presence of ischemia, 70 should be the aim.

•     Keep your weight to normal / even a little less
•     Quit smoking, if you are a smoker
•     Do regular EXERCISE – say walking or jogging - 20 minutes a day / at least 5 days in a week. Isometric exercise (like bull worker) is bad.
•     Healthy FOOD is a must. Avoid saturated fats – coconut oil, palm oil, butter, ghee, full cream milk...Avoid
junk foods in particular – French fries have palm oil / Pizza has cheese / Indian sweets are made in ghee...
Change to Poly-un-saturated oil – like sun flower oil.
Include Mono-un-saturated oil – Olive oil.
Repeat the test in 6 weeks.
•     Cholesterol can still be high, in spite of diet and exercise – you need drugs; Because it is also manufactured in the liver – and that is determined by heredity. Statin is the first choice. Some start it straight away – even with normal levels, even without problems (Primary Prophylaxis)

ISCHEMIA
     TMT suggests ischemia. That is an indication for further work up. Occasionally there may be false positive or false negatives. The best solution is Angiography. It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on.
     It is the gold standard against which all other investigations are compared. Why are you opting for non-invasive investigation?
     If you insist, the thing to do will be to repeat the stress test with Thallium isotope – Thallium stress TMT – to see whether the blood arriving at the heart muscle.
     CT angiogram (124 slice or higher) can show the anatomy of blood vessels

The aim of any investigation is to modify the treatment, based on the result.
Intervention – dilatation with balloon and placing a stent (Angioplasty) - or CABG (Coronary Artery Bypass Graft) may be advised based on the results.

MEDICINE
Aspirin in small doses – 80 to 100 mg – is a routine. It acts on the platelets and helps to reduce clot formation.
There are several others –
At this stage, you start with aspirin and statin.. Your treating doctor will prescribe appropriately.

Take care
Wishing you speedy recovery
God bless
Good luck

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Dear XXXXXXX
You have asked too many questions –
I have kept your questions – as it is / and given answers – below each

1.ECG is nornal. all blood tests are normal except LDL 131 and Chol: 212
     LDL is bad. It is risk for heart attack

2. In TMT, result is mentioned as positive for inducible ischemia, and Echo results are normal. I completed the full mets without any difficulty. What is the significance of inducible ischemia? What is the difference between mild ischemia and inducible ischemia?.
     Mild means it is not severe
     Inducible here means it can be is brought on by work

2.cardiologist advised me to change the life style, food habits, excercise. also prescribed a. razel 10 mg b. coversyl 2 mg daily for six months.
     Razel is a statin – to reduce LDL.
     Coversyl is ACE inhibitor – helps in pressure, heart remodelling and so on

3. Since there is no symptoms or discomfort in daily life, I would like to know whether these medicines sufficient to reduce or avoid blocks. or Angio is needed immediately. Whether medicines will reduce or elliminate? any other aspirin medicines to be added
     Absence of symptom is not proof of absecnce of disease
     These medicines are good. They may not be sufficient by themselves.
     Yes, aspirin is also needed – until angio can rule out. Even if it rules out, it can be beneficial.
     Angio is needed – as soon as possible

4. What are the symptoms for severe ischemia
     Sudden death / Chest pain / Breathlessness and so on

5. whether i can use treadmill and can do normal activities, continue sex
     There is no problem for routine activity
     Treadmill can be done first under supervision; it is actually a part of rehabilitation and training
     At your level of exercise capacity, there is no contraindication for sex

6. What are the diet or food items i have to avoid or take
     Avoid high fat diet. Avoid saturated fats. Keep your weight less. Consult a dietician

7. I learn that there may be side effects of coversyl, it may create ED, In that case, What is the alternate,
     Coversyl generally does not cause ED – uncommon not unknown. The dose is also small.
     Any drug can – even placebo! / Anxiety at diagnosis can cause
     Alternative and similar drug is any ARB      

8. Sorry for many questions, because I am very much upset , please guide me in these aspects
     You have too many doubts – because you have not discussed with your treating doctor.
     The best and only approach will be to have further investigations to confirm or exclude.

Good luck

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