u/rockstar_stark

Hi everyone,

My mother (52F) recently underwent a routine health checkup. Her Treadmill Test (TMT) came back positive for inducible ischaemia.

The consulting doctor has advised an immediate angiogram and a stent if required. We are a bit anxious about jumping straight into an invasive procedure and are looking for some local guidance.

For any doctors or medical professionals in the sub, here are the brief stats:

- TMT Protocol: BRUCE. Exercise Time: 4:01 mins

- Workload: 5.4 METs. Max HR: 157 bpm (93% of max predictable)

- ECG: ST depression noted in V6, II, III, aVF (Max depression at 3:38).

- Observations: Patient felt "uncomfortable" during the test, but no angina/arrhythmia was noted.

- Spirometry: Showed early small airway obstruction/mild restriction.

My questions for the community:

1. Personal Experiences: Have you or your parents/relatives been in a situation where a TMT came back positive? Did you proceed straight to the angiogram, or did you opt for further non-invasive tests first (like a CT Angio or Stress Echo)? Were there any false positives?

2. Hospital Recommendations: Which are the most trustworthy hospitals or cardiologists in **Coimbatore** for a reliable second opinion and a potential angiogram? We are looking for doctors who are ethical and won't push for unnecessary stenting.

Any shared experiences or recommendations would be incredibly helpful for her to make an informed decision. Thank you!

Asking for my **mother.**

**Preliminary context:**

We did a full body checkup. ECG and Echo results were normal, but TMT results said otherwise, based on which doctor suggested angiogram and place stent if required. She is also diagnosed with one of her kidney being contracted for which I've added details in the end (As per doctor more than the kidney, the angio suggestion needs to be considered critical and immediately acted upon)

**Note:**

In the recent past, last 6 months she did convey she had slight pains near her chest. But ignored it assuming it might be gastric. The TMT was taken a week ago.

Demographics:

Age/Sex: 52F

Height: 154 cm

Weight: 67 kg

Smoking Status: Non-smoker

Primary Issue: She underwent a routine Treadmill Test (TMT) and Spirometry. Based on the TMT, the consulting doctor has suggested an angiogram and a stent if required. Seeking a second opinion/insights on the exact findings below.

TMT (Treadmill Test) Findings:

Protocol: BRUCE

Exercise Time: 4:01 minutes

Workload attained: 5.4 METs (Fair Effort Tolerance)

Heart Rate: Max HR attained 157 bpm (93% of Max Predictable HR of 168)

Max Blood Pressure: 130/90 mmHg

ECG Changes: ST depression noted in leads V6, II, III, aVF.

Maximum ST Depression: Occurred at 3:38.

Clinical Observations during test: Patient reported "Feeling Uncomfortable". No Angina, no arrhythmia, no S3, no murmur noted.

Final Impression: Test is positive for inducible ischaemia.

Spirometry Findings:

Pre-Medication Impression: Indicates early small airway obstruction (as FEF 25-75 %Pred or PEFR %Pred < 70) and mild restriction (as (FEV1/FVC)%Pred >95 and FVC%Pred <80).

Any insights into the severity of the ST depressions based on the METs achieved, and whether proceeding straight to an angiogram is the standard next step, would be highly appreciated.

**I am not sure on whether to proceed with the invasive treatment. Not sure of the severity. Please suggest whether it can be treated with proper lifestyle changes or angio is mandatory.**

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Regarding her kidney issue, doctor informed that one of her kidney is kind of shrunken to 1/4th of its size and it is chronic. Since other kidney is 100% functional without any issues, they suggested prioritising heart issue over finding the reason for single kidney failure.