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

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