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Dr. Andrew Rynne

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What do my lab test reports indicate?

Answered by
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Dr. Sagar Makode

Cardiologist

Practicing since :2013

Answered : 1730 Questions

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Posted on Fri, 3 Mar 2017 in Hypertension and Heart Disease
Question: My mother aged 59 having DIABETES from past 2 years, she went through health checkup, all the other tests very fine except for TMT and Lipid profile.
Currently she is not having any typical symptoms of heart issues such as shortness of breath,sweating or chest pain.
However cardiologist(junior) who looked at the report did not suggest Angiography, only Ecosprin-75 was prescribed.

how bad TMT report looks, should we check with another cardiologist and go for Angiography?
Please have a look at the attached TMT reports and please adivce on this.

ECG - Normal

Stress Test TMT Results:
------------------------
Patient execercised according to XXXXXXX for 4:24mins, METS:7.0
MODERATE EFFORT TOLERANCE
NORMAL HR & BP RESPONSE , NO ANGINA/ARRHYTHYMIAS
ST-T CHANGES NOTED DURING EXERCISE AND RECOVERY
STRESS TEST POSITIVE FOR EXERCISE INDUCIBLE ISCHEMIA

Lipid Profile:
-------------
LDL - 183 mg/dL
HDL - 53 mg/dL
TRIGLYCRIDES - 302 mg/dL

Our endocrinologist prescribed following for cholesterol apart from regular tablets for blood sugar
Roseday 10mg - once a day
Megaza - once a day

Her current medications:
OLMY 20, GLYCOMET GP 1 FORTE, ECOSPRIN-75, ROSEDAY 10, MEGAZA 1G, GLYCOMET 500MG (All once a day)

Thank You Very Much
Shri
doctor
Answered by Dr. Sagar Makode 1 hour later
Brief Answer:
Yes, she should undergo angiography

Detailed Answer:
hello,
Her tmt is positive for inducible ischemia, so she should undergo angio to quantify the blockages, although not very urgently. Report indicates, at rest or mild to moderate activities, her heart is having adequate blood supply however at stressful condition and higher heart rates, heart is deprived of blood supply. Also, diabetic patients sometimes, may not have any typical symptoms of heart problem like pain. Although, it can sometimes be falsely positive, but she should have angio. After angio, depending upon the report she may need angioplasty or bypass surgery.
Also, current medicine should be continued and she should have a healthy lifestyle like avoiding fatty, oily, and high calorie, sugary diet. Have low salt diet and monitor blood pressure regularly. Regular exercises like brisk walking atleast 30 min a day and 5 days a week. Lots of green leafy vegetables, fruits, fish once or twice a week, avoid meat.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sagar Makode 1 hour later
Thank for your reply Doctor,
I have few more question, need you advice:

1. How long can we wait before Angiography is done?

2. How bad is blood supply at stressful situation/high heart rate (is it pretty normal for women at her age)?

3. Do you see any indication from the tmt report that it may be false positive?

4. Is there a way to confirm tmt being false positive (like repeating tmt or something else) before we decide to go for angiography?

5. For the current condition is medical management with tablets is enough?
doctor
Answered by Dr. Sagar Makode 7 hours later
Brief Answer:
Can be managed medically Also

Detailed Answer:
first, we can certainly wait because blockages are not critical, that means they are coming into the pictures only at stress. Exact time can't be predicted, but if she start getting symptoms like heaviness or pain, sweating etc on exertion, not responding to medicine then it will become the priority. Severity of blockages can't be reliably predicted from tmt, but doesn't look like a severe one.
It can be certainly be managed on medicine. Also, false positivity can't be told from tmt report. This can be assessed by either a stress thallium or ct coronary angiography which are minor test. So she can undergo it to further ascertain the blockages.

Above answer was peer-reviewed by : Dr. Nagamani Ng
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