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Test Reports Show Cholesterol(serum)-211, HDL-50 And LDL-132. Does It Indicate Positive For Inducible Ischaemia?

Posted on Thu, 12 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 ?

Answered by Dr. Rakesh Madhyastha (33 minutes later)

Brief Answer: Angiogram is the next step Detailed Answer: Hello Thanks for the query It looks like your father is having a a few blocks in the coronaries which are compromising his exercising ability. ( Blocks in the heart) Here are my interpretations 1. Total cholesterol is on the higher side, he needs to be on medications for it as of now but he definitely needs life style modifications like walking for 30 min daily, avoiding oily food items. Get it rechecked after 3 months 2. S creat is also high normal, it is expected in this age but it would be a good idea to put him on an ACE inhibitor or an ARB drug to protect his kidneys. I would also recommend you to get a 24 hour urine protein before starting on these drugs. 3. TMT report is suggestive of an inducible ischemia. Which means that in stressful conditions the heart is not able to cope up with the increased demand of blood supply, which might be the reason for his early fatigue and shortness of breath. Please approach a cardiologist for an angiogram, if they find significant blocks they will put a stent in the blood vessel to improve the blood supply I hope I was of help, if you have any further queries please get back to me I wish your father good health Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (42 hours later)

Thanks doctor for your reply, sending complete TMT reports as attachment . 1) Based on your reply , I am sending you detailed report ,please tell me whether the report indicates blocks or problem in heart, where and in which page they are indicating. Doctor can you be detailed . 2) As a doctor , what would be your final impression on report , suggestions and advise to patient. Regards, XXXXXXX

Answered by Dr. Rakesh Madhyastha (15 hours later)

Brief Answer: Hello Detailed Answer: Thanks for the reply and attaching the full report. I am sorry for the short delay in my reply, I was on call at my hospital 1. Pages 2,3,4 and 5 show T wave inversions which are indicative of ischemic events. It means that the coronary arteries are not able to supply adequate blood supply to the heart. There is an increased demand on the heart during stressful situation like anxiety, exercise, etc which causes an increase in heart heart, this increase in heart rate is brought about by various mechanisms in order to increase the supply of the blood to the rest of the body. This increase in heart rate means that the heart also requires more blood supply and it is the coronary arteries which supplies blood to the heart which is slightly compromised in your father, most likely due to age related atherosclerosis. Atherosclerosis is nothing but fat deposition within the arteries causing blockage of the arteries. It is an age related issue 2. My final impression and suggestion remains same as my previous reply to you. If my patient came with this TMT report I would advice him to undergo an angiogram as soon as possible. I would also advice him not to engage in strenuous physical activities until the angiogram is done I would like to add here that angiogram is a same and a simple procedure. Elective procedures carry very minimal risk. Please approach a good cardiologist as soon as possible. I hope I was of help Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (11 hours later)

Thanks doctor for your valuable suggestions and advise, i will come to final point. My father took health checkup in Apollo, Hyderabad on 18/07/2011, and showed all reports to Consultant Internal Medicine. Doctor said everything is fine and my father moved to my place on 19/07/2011. That evening , he was feeling uneasy and chest pain, as doctor said fine , he took gastric medicine. As he couldn't relieve pain , went to local doctor and took ECG, next minute they put a tablet under tongue and moved him to vijayawada. And on 20/07/2011 ,he was placed with stent. All this happened within 30 hours of health checkup. Report by Vijayawada Emergency Doctor:This is to certify that Dr.D XXXXXXX XXXXXXX aged 65 years , was admitted in our hospital on 20/07/2011 with a diagnosis of Acute inferoposterior wall M1, Killips C1.11, Mild to Moderate LV Systolic Dysfunction, HTN. He underwent coronary angiogram on 20/07/2011 which revealed double vessel disease with RCA 100% blocked in the mid segment and Primary PCI with stent to Mid RCA on 20/07/2011. He was discharged on 24/07/2011. We delayed nearly 6-8 hours, after pain. By god Grace he is well, if anything would have happen, we are the suffers. .I purely think this as medical negligence . Please see final impression given by Apollo doctor - Consultant Internal Medicine. So we filed a case in Andhra Pradesh State Consumer Forum. We need Doctors advise. Reports shows TMT Positive and final impression shows TMT Negative given by Apollo doctor. Uploaded Final impression given by Apollo Doctor. 1) That's why doctor everytime , i been insisting you , what would you do , if you were in that place. 2) Do you think its purely medical Negligence or not. Do i have sufficient evidence, to fight. 3)Needed valuable suggestions and advise, it will be great helpful to us. Regards, XXXXXXX

Answered by Dr. Rakesh Madhyastha (1 hour later)

Brief Answer: Hello Detailed Answer: Thanks for the reply It is certainly unfortunate what had happened to your day, I am happy he is doing well. 1. I have already discussed my opinion on what I would do if that TMT report was given to me. 2. It might not be medical negligence as your dad did have good effort tolerance in TMT. Inducible ischemia is not an emergency and angiogram is elective in such cases 3. I have already given my suggestions and advice, please do take a second opinion from a cardiologist in writing. I wish you all the best Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar