I am gastritis and sugar and blood pressure patients and also heart pain, heart side tight back and left hand pain suffer last 2 months. Last day I visited Dr. for Cardiologist he sugest me TMT and angiography .for further diagnosis. Is it proper. Tell me.
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Exercise stress test (also called treadmill test) is an important investigation not only in patients with suspected cad but also in established cad. In the former group, it helps us to exclude cad in patients with chest pain and in the later group, it helps us to assess functional capacity, risk stratification and to detect any additional (new or residual) ischemia. Stress test being a physiological test, has a huge advantage of assessing the adequacy of myocardial blood flow without even knowing the coronary anatomy, while coronary angiogram (cag) has a zero physiological value* in spite of excellent assessment of the coronary anatomy! it is an irony, in the assessment of angina we are expected to assess the physiological adequacy of myocardial blood flow, we have kept coronary angiogram as a gold standard over and above the much neglected physiological stress test. Of course, the limitation of stress test is that, it has only 75% specificity (to rule out cad) and about 80% sensitivity (to detect cad. In simple terms stress test is likely to miss 20% times to miss a cad in patients with cad and 25% of times falsely diagnose cad in patients without cad. In the above statistics, coronary angiogram was considered gold standard. The problem with this data is that, cag is not the real gold standard, but it was nominated as a gold standard. We now know normal coronary angiogram is not equivalent to normal coronary arteries and vice versa. While both test have limitations, it is logical to believe cag has an edge over stress test since it visualises the anatomy. But, once an obstruction is demonstrated by cag, stress test scores over in assessing the physiological impact of the lesion.
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