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Pain in arms after exertion. Family history of IHD. Should I undergo cather angio?

Hellow, m also neurophysicion working in for off place of pakistan. I have strong family history of IHD and my age is 37. I have HTN for the last 5 years and taking ARBs. I am really worried about exertional pain in the inner aspect of my arms but not in the chest . My work up done includes ETT that shows T inversion in V5 and v6 but no ST segment changes. CT angiography done in pakistan institute of medical sciences Islamabad was normal . ECG and Echocardiography normal. My question is should I undergo cather angio or its ok and i should try to forget it. But its very much related to exertion and being a doctor its difficult to ingore it.
Asked On : Thu, 18 Oct 2012
Answers:  2 Views:  30
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Internal Medicine Specialist 's  Response
Hello Dr Mazharhamdani

Welcome to HCM

You are hypertensive for last 5 years along with positive family history of IHD, Exertional pain we always suspect angina and as your CT angio is normal and negative TMT a significant epicardial coronary disease is ruled out.
Angina is clinical diagnosis so possibility of microvascular disease and a coronary spasm may be there.
Coronary angiography may not be required,but disscuss with your cardiologist about changing antihypertensive to beta blocker or Calcium channel blockermay be used as it will take care of angina and blood pressure.
Other risk factors must be taken care like Lipid Profile,Diabetes,Overweight and Smoking.
Any risk factor present must be taken care if present.
In consultation with Cardiologist preventive drugs like statin and aspirin may be used.
Other small risk factors Uric acid,Homocysteine,level of CRP may be checked and treated if abnormal.
Take care
Best of luck

Answered: Wed, 31 Oct 2012
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Cardiologist Dr. Aslam Lalani's  Response
Hello Dr.
CT coronary angiogram test has high negative predictive value means if CT Coronary angiogram normal means there is no epicardial coronary artery stenosis
i think no need for cather angio at present
your symptoms related to exertion may be because of spasm of epicardial coronary artery or related to small vessel disease if at all it related to heart
take care
Answered: Wed, 24 Oct 2012
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