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  #1  
Old 11-11-2009
sunny86's Avatar
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Heart TMT dilemma

The following question had me a bit confused..
A 59yr old male with positive family history for CAD undergoes Exercise Stress testing(TMT-Bruce protocol) as routine screening for health insurance. He is a hypertensive under medication losartan+Hydrochlorthiazide since 1 year and beta-blocker therapy for 3 years prior to that. He was asymptomatic before
and remains so throughout the test.

Test results are as follows:
Good effort tolerance,
Total mets achieved 10.2,
Normal heart rate (94% of target HR)& normal BP response for achieved work load.
Resting ECG shows sinus rhythm and 0.5 to 1 mm horizontal to downsloping ST depression in inferolateral leads. There was a further 1mm downsloping
ST depression noted during peak exercise in above leads which became less after 3 minutes of recovery.
No chest pain or dyspnoea during the test.
Reason for termination- ECG changes.

He is non diabetic and lipid profile is normal.

What would be the next step in managing the case??

a. Invasive procedure(angiogram)
b. Non invasive procedure(thallium perfusion CT/Tc 99)
c. prophylactic statins and aspirin
d. repeat stress test after few weeks
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  #2  
Old 11-11-2009
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i think its option B,cz hypertension is one of the major cause of Ischemic heart disease.hope am right!!!
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Old 11-11-2009
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This is not step 1 question
this is step 3 question
I think option B
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Old 11-11-2009
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Default Answer?

B would be the most logical answer, because
a) further evaluation is necessary, because of the many risk factors i.e., hypertension and a positive family history
b) as the patient is asymptomatic, it is unethical to subject him to angiogram. the procedure itself has a higher mortality rate. The 4 yr survival rate of such a person without any intervention is 99%. Also, angiogram is useful only if the lumen is narrowed. Atherosclerosis doesn't show up on it until the vessel wall is narrowed.

Thanks for replying..
I would be glad if you could provide me with any possible other options..
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